May 1, 2020

CMS Interim Final Rule: Summary of Key Telehealth Provisions

CMS Interim Final Rule (Part 2)


On April 30, 2020, the Centers for Medicare and Medicaid Services issued an updated interim final rule that further expands Medicare coverage for telehealth. ATA has worked closely with members to advocate for these key policy changes and applauds CMS for continuing to support the rapid expansion of telehealth and digital health technologies to combat COVID-19.

Key Telehealth, Digital Health, RPM Provisions

Resources:

CMS April 30 Interim Final Rule

CMS Provider Fact Sheets

 


Additional Providers Now Eligible for Telehealth

  • For the duration of the Coronavirus PHE, CMS is waiving limitations on the types of practitioners that can furnish Medicare telehealth services to include all practitioners eligible to bill Medicare for professional services, including physical therapists, occupational therapists, and speech language pathologists, etc.
  • Prior to this waiver, only physicians, nurse practitioners, physician assistants, and certain other providers could deliver Medicare telehealth services.
  • As a reminder, newly eligible providers must still comply with applicable state practice and licensure requirements.

Payment for COVID-19 Remote Physiologic Monitoring (RPM) Services 

  • For the duration of the Coronavirus PHE, and for the purposes of treating suspected COVID-19 infections, CMS will now allow RPM monitoring services to be reported to Medicare for periods of time that are fewer than 16 days of 30 days, but no less than 2 days, as long as the other requirements for billing the code are met.
  • Payment for CPT codes 99454, 99453, 99091, 99457, and 99458 when monitoring lasts for fewer than 16 days of 30 days, but no less than 2 days, is limited to patients who have a suspected or confirmed diagnosis of COVID-19.

Audio-only Telehealth Services

  • CMS has waived the interactive audio-video requirement for certain telehealth evaluation and management services – enabling providers to bill Medicare for certain services delivered by audio-only phones. As a result, Medicare beneficiaries will be able to use an audio-only telephone to access these services.
  • CMS has updated the list of eligible codes on the Medicare telehealth services list and clearly marked which codes are eligible for audio-only.

Payment Parity for Audio-only Telephone Codes

  • CMS has recognized the need to better support audio-only telephone services by increasing payments for telephone visits to match payments for office and outpatient visits. CMS is increasing payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.
  • CMS has crosswalked payment rates for CPT codes 99212, 99213, and 99214 to 99441, 99442, and 99443 and is finalizing on an interim basis and for the duration of the COVID-19 PHE the following work RVUs: 0.48 for CPT code 99441; 0.97 for CPT code 99442; and 1.50 for CPT code 99443.
  • CMS has finalized the direct PE inputs associated with CPT code 99212 for CPT code 99441, the direct PE inputs associated with CPT code 99213 for CPT code 99442, and the direct PE inputs associated with CPT code 99214 for CPT code 99443.
  • CMS  will not increase payment rates for CPT codes 98966-98968 as these codes describe services furnished by practitioners who cannot independently bill for E/Ms and so these telephone assessment and management services, by definition, are not furnished in lieu of an office/outpatient E/M service.

Hospitals/HOPD Telehealth Expansion

  • CMS is now allowing hospitals to bill the originating site facility fee for telehealth services furnished by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is located at home.
  • Hospitals may bill for services furnished remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is at home when the home is serving as a temporary provider based department (PBD) of the hospital. Examples of such services include counseling and educational service as well as therapy services. This change expands the types of healthcare providers that can provide using telehealth technology.

Medicare Shared Savings Program

CMS has determined that virtual services, either telehealth, virtual check-ins, e-visits or telephone, in the definition of primary care services to ensure that physicians and other practitioners can offer options to beneficiaries whom they treat, while also allowing this care to be included in our consideration of where beneficiaries receive the plurality of their primary care, for purposes of assigning beneficiaries to ACOs.

  • HCPCS code G2010 (remote evaluation of patient video/images) and HCPCS code G2012 (virtual check-in)
  • CPT codes 99421, 99422 and 99423 (online digital evaluation and management service (e-visit))
  • CPT codes 99441, 99442, and 99443 (telephone evaluation and management services)

Opioid Treatment Programs – Furnishing Periodic Assessments via Communication
Technology

  • CMS has implemented a change to allow periodic assessments furnished by OTPs to be furnished via two-way interactive audio-video communication technology, and in cases where beneficiaries do not have access to two-way audio/video communications technology, to allow periodic assessments to be furnished using audio-only telephone calls rather than via two-way interactive audio-video communication technology, provided all other applicable requirements are met.
  • In the CY 2020 PFS final rule (84 FR 62634), CMS finalized an add-on code describing periodic assessments furnished by OTPs (HCPCS G2077 (Periodic assessment; assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment).

Additional Flexibility Under the CMS Teaching Physician Regulations 

  • CMS has determined that, for the duration of the PHE for the COVID-19 pandemic, the teaching physician may not only direct the care furnished by residents, but also review the services provided with the resident, during or immediately after the visit, remotely through virtual means via audio/video real time communications technology.
  • Also for the duration of the COVID-19 PHE, Medicare may make PFS payment to the teaching physician for the following additional services when furnished by a resident under the primary care exception:
    • CPT codes 99441 – 99443 (Telephone evaluation and management service by a physician or
      other qualified health care professional who may report evaluation and management services
      provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment;
    • CPT codes 99495 -99496 (Transitional Care Management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge; medical decision making of at least moderate complexity during the service period; face-to-face visit)
    • CPT codes 99421 – 99432 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days)
    • CPT code 99452 (Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified health care professional, 30 minutes);
    • HCPCS code G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure  within the next 24 hours or soonest available appointment; 5–10 minutes of medical discussion); and
    • HCPCS code G2010 (Remote evaluation of recorded video and/or images submitted by an
      established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment).
  • CMS has also clarified that when selecting the level of office/outpatient E/M visits when furnished as Medicare Telehealth services  that the office/outpatient E/M level selection for services under the primary care exception when furnished via telehealth can be based on MDM or time, with time defined as all of the time associated with the E/M on the day of the encounter; and the requirements regarding documentation of history and/or physical exam.
  • CMS has made additional changes to Teaching Phycians Regulations, which can be found on Pg. 130 of the IFC

CARES-mandated FQHC/RHC Telehealth Expansion

As mandated by the CARES Act, CMS will now reimburse for Medicare telehealth services provided by federally qualified health clinics  (FQHC) and rural health clinics (RHC). Under pre-COVID CMS policy, these clinics were not eligible distant site providers.


Opioid Treatment and Bundled Payment Programs

CMS’s bundled payment program for opioid treatment plans includes add-on payments for performing periodic assessments of treatments and services. CMS will now permit these assessments to be performed either by two-way audio/video technology, or by audio only.


Streamlined Process for Adding Codes to the Medicare Telehealth Services List

During the Coronavirus PHE, CMS will add new telehealth services on a sub-regulatory basis, rather than through annual rulemaking. The agency will now consider requests on a rolling basis.