Medicare Telemedicine Coding & Reimbursement Guidelines for COVID-19
CMS has expanded the benefit of telemedicine services on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act (CMS, 2020). CMS released the Medicare telemedicine coding and reimbursement guidelines for healthcare providers to use during the COVID-19 pandemic (CMS, 2020).
Reimbursement and Coding for Medicare Recipients
According to the CMS Medicare Telemedicine Health Care Provider Fact Sheet, reimbursement for these visits are considered the same as in-person visits and are paid at the same rate (CMS, 2020). The U.S. Department of Health & Human Services Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs (CMS, 2020).
Services may be billed using CPT code 99421-99423 and HCPCS codes G2061-G2063, as applicable. Please see below the Summary of Medicare Telemedicine Services, taken from the CMS website (2020).
Summary of Medicare Telemedicine Services
How would this affect Providers? And what are the HIPAA implications? See more here. Further details on the impact on coding due to the 1135 Waiver Authority and Coronavirus Preparedness and Response Supplemental Appropriations Act here. In addition, CMS clarified the risk adjustment criteria for coding telehealth services, which we outlined here.