CMS Announces New COVID-19 Telehealth Flexibilities
POLICY UPDATE - 3.31.20
The Administration announced late yesterday sweeping new changes to Medicare in response to the COVID-19 emergency, including a new tranche of flexibilities and waivers – building on the agency’s March 17 actions – designed to further expand telehealth and virtual care for Medicare beneficiaries.
Many of these critical policy updates were included in ATA’s recent recommendations to the agency and we appreciate the support and continued engagement from members to highlight barriers to providing care during this critical time. We will continue to assess the current landscape and request that members continue to provide feedback that can be shared with the Administration.
TOP 16 CMS TELEHEALTH POLICY UPDATES
1. New Medicare Telehealth Services: CMS will now allow for more than 80 additional telehealth services for Medicare patients. New codes include:
- Emergency Department Visits, Levels 1-5 (CPT codes 99281-99285)
- Initial and Subsequent Observation and Observation Discharge Day Management (CPT codes 99217- 99220; CPT codes 99224- 99226; CPT codes 99234- 99236)
- Initial hospital care and hospital discharge day management (CPT codes 99221-99223; CPT codes 99238- 99239)
- Initial nursing facility visits, All levels (Low, Moderate, and High Complexity) and nursing facility discharge day management (CPT codes 99304-99306; CPT codes 99315-99316)
- Critical Care Services (CPT codes 99291-99292)
- Domiciliary, Rest Home, or Custodial Care services, New and Established patients (CPT codes 99327- 99328; CPT codes 99334-99337)
- Home Visits, New and Established Patients, All levels (CPT codes 99341- 99345; CPT codes 99347- 99350)
- Inpatient Neonatal and Pediatric Critical Care, Initial and Subsequent (CPT codes 99468- 99473; CPT codes 99475- 99476)
- Initial and Continuing Intensive Care Services (CPT code 99477- 994780)
- Care Planning for Patients with Cognitive Impairment (CPT code 99483)
- Psychological and Neuropsychological Testing (CPT codes 96130- 96133; CPT codes 96136- 96139)
- Therapy Services, Physical and Occupational Therapy, All levels (CPT codes 97161- 97168; CPT codes 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507)
- Radiation Treatment Management Services (CPT codes 77427)
2. Parity for Telehealth Services: Providers billing for Medicare telehealth services can now report the POS code that would have been reported had the service been furnished in person. During the coronavirus PHE, providers can use the CPT telehealth modifier, modifier 95, which should be applied to claim lines that describe services furnished via telehealth.
3. Virtual Check-ins: Providers can now use ‘virtual check-in services’ (HCPCS codes G2010, G2012) for both new and established patients, previously only allowed for established patients.
4. E-Visits Expanded to New Providers: E-visits are now eligible to be used by an expanded list of providers (HCPCS codes G2061-G2063), including licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists whom are eligible to paid.
5. Expanded RPM Coverage. Remote patient monitoring allowed for both new and established patients. Clarification that RPM (CPT codes 99091, 99457-99458, 99473- 99474, 99493-99494) can be used for both acute and chronic conditions, including patients with only one disease. Examples include monitoring oxygen saturation levels using pulse oximetry.
6. Coverage for Audio-only Telephone E/M: Providers can now provide certain services by telephone during the COVID-19 PHE, to both new and established patients (under enforcement discretion) via separate payment for CPT codes 98966-98968 and CPT codes 99441-99443.
7. Frequency Limitations on Medicare Telehealth Services Lifted. Limitations on the number of times certain services that can be provided via Medicare telehealth have been eliminated for certain services, including subsequent inpatient visits, subsequent skilled nursing facility visits, and critical care consults.
8. Medicare Physician Supervision Requirements: For services requiring direct supervision by the physician or other practitioner, physician supervision can now be provided virtually using real-time audio/video technology.
9. End Stage Renal Disease (ESRD): Clinicians no longer must have one “hands on” visit per month for the current required clinical examination and may use telehealth to meet requirements.
10. Medicare Beneficiary Consent: Annual consent may be obtained at the same time, and not necessarily before.
11. Home Health Agency & Telehealth: HHAs can provide more telehealth services to beneficiaries within the 30-day episode of care, if part of plan of care, and does not replace needed in-person visits.
12. Hospice Care & Telehealth: Face-to-face encounters for purposes of patient recertification can now be conducted via telehealth. Providers can now provide services to a Medicare patient receiving routine home care through telehealth
13. Nursing Home Telehealth Expansion: Physicians and non-physician practitioners permitted to perform in-person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth.
14. Inpatient Rehabilitation Facility (IRF) Face-to-Face Requirement: Rehabilitation physicians to use telehealth services to conduct the required 3 physician visits per week.
15. FHQC/RHC: While not technically expanded under the interim final rule announced by CMS yesterday, the CARES Act has provided CMS addition authority to expand Medicare telehealth for FHQC/RHC and we expect the agency to provide an update on waiving the distant site restrictions for FHQC/RHC soon.
For details on these policy changes and more, please closely review the relevant CMS guidance and interim final rule below.
CMS guidance and interim final rule:
- CMS: Waivers & flexibilities for Health Care Providers
- CMS: Provider Enrollment Relief Frequently Asked Questions
- CMS: Medicare IFC: Revisions in Response to the COVID-19 Public Health Emergency (CMS-1744-IFC)
CMS has also published provider-specific fact sheets here:
- Physicians and Other Practitioners
- Teaching Hospitals, Teaching Physicians and Medical Residents
- Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities)
- Home Health Agencies
- Inpatient Rehabilitation Facilities
- Long Term Care Hospitals & Extended Neoplastic Disease Care Hospitals
- Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
- End Stage Renal Disease (ESRD) Facilities
- Durable Medical Equipment
- Participants in the Medicare Diabetes Prevention Program
- Medicare Advantage and Part D Plans