Last week the Centers for Medicare & Medicaid Services (aka “CMS” or “Medicare”) significantly changed its telehealth reimbursement rules to adjust to the demands of the COVID-19 crisis. These Medicare telehealth changes impact workers’ comp providers because many states mirror or closely mirror Medicare telehealth reimbursement rules.
Over the next several blog posts we will provide details of the Medicare changes that were announced last week, including:
- Waiver of the types of practitioners allowed to furnish telehealth services.
- Medical services added to the allowed telehealth service list.
- Audio-only telehealth allowed for designated medical services.
- Reimbursement increase for audio-only telephone evaluation and management services.
- Applying time spent by provider, rather than medical decision making, to select level of evaluation and management services furnished via telehealth.
Medicare-Relevant Publication Links
As Medicare rapidly releases updates to telehealth rules and regulations, accessing the relevant documentation is imperative to understanding these updates. To trace the details imparted in the blog posts published over the next several days, the following is a complete list of the referenced documents:
- COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers - Updated 4/30/2020
- List of Telehealth Services
- Medicare and Medicaid Coronavirus Waivers & Flexibilities
- Medicare and Medicaid IFC: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-5531 IFC) (PDF)
- Medicare IFC: Revisions in Response to the COVID-19 Public Health Emergency (CMS-1744-IFC) (PDF)
- Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic
Expanded List of Practitioners Allowed to Furnish Telehealth
CMS now allows health care professionals who were previously ineligible to furnish and bill for Medicare telehealth services, including physical therapists, occupational therapists, speech language pathologists, and others, to receive payment for Medicare telehealth services. Medicare is waiving the distant site provider requirements which restricted the types of providers allowed to bill for telehealth services. This waiver expands the types of health care professionals that can furnish distant site telehealth services to include all those that are eligible to bill Medicare for their professional services.
Telehealth Services Added Effective 4/30/2020
On April 30, 2020 CMS added new services to its List of Telehealth Services that are eligible for reimbursement when furnished via telehealth. Further, Medicare announced that it will continue to add services to the Medicare telehealth list on a subregulatory basis by posting new services to the web listing of telehealth services when the agency receives a request to add (or identifies through internal review) an appropriate service. The criteria for appropriateness is that the service can be furnished in full, as described by the relevant code, by a distant site practitioner to a beneficiary in a manner that is similar to the in-person service.
The following table lists the new telehealth services added to the Medicare List of Telehealth Services.
Code |
Short Descriptor |
Status |
Can Audio-only Interaction Meet Requirements? |
90875 |
Psychophysiological therapy |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
90956 |
Esrd srv 1 visit p mo 2-11 |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
92002 |
Eye exam new patient |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
92004 |
Eye exam new patient |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
92012 |
Eye exam establish patient |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
92014 |
Eye exam&tx estab pt 1/>vst |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
92508 |
Speech/hearing therapy |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
Yes |
92601 |
Cochlear implt f/up exam <7 |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
92602 |
Reprogram cochlear implt <7 |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
92603 |
Cochlear implt f/up exam 7/> |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
92604 |
Reprogram cochlear implt 7/> |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
94002 |
Vent mgmt inpat init day |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
94003 |
Vent mgmt inpat subq day |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
94004 |
Vent mgmt nf per day |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
94005 |
Home vent mgmt supervision |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
94664 |
Evaluate pt use of inhaler |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
96110 |
Developmental screen w/score |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
96112 |
Devel tst phys/qhp 1st hr |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
96113 |
Devel tst phys/qhp ea addl |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
96121 |
Nubhvl xm phy/qhp ea addl hr |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
Yes |
96127 |
Brief emotional/behav assmt |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
Yes |
96158 |
Hlth bhv ivntj indiv 1st 30 |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
Yes |
96170 |
Hlth bhv ivntj fam wo pt 1st |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
96171 |
Hlth bhv ivntj fam w/o pt ea |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
97150 |
Group therapeutic procedures |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
97151 |
Bhv id assmt by phys/qhp |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
97152 |
Bhv id suprt assmt by 1 tech |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
97153 |
Adaptive behavior tx by tech |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
97154 |
Grp adapt bhv tx by tech |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
97155 |
Adapt behavior tx phys/qhp |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
97156 |
Fam adapt bhv tx gdn phy/qhp |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
97157 |
Mult fam adapt bhv tx gdn |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
97158 |
Grp adapt bhv tx by phy/qhp |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
97530 |
Therapeutic activities |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
97542 |
Wheelchair mngment training |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
99324 |
Domicil/r-home visit new pat |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
99325 |
Domicil/r-home visit new pat |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
99326 |
Domicil/r-home visit new pat |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
99441 |
Phone e/m phys/qhp 5-10 min |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
Yes |
99442 |
Phone e/m phys/qhp 11-20 min |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
Yes |
99443 |
Phone e/m phys/qhp 21-30 min |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
Yes |
0373T |
Adapt bhv tx ea 15 min |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
S9152 |
Speech therapy, re-eval |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
0362T |
Bhv id suprt assmt ea 15 min |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
G0410 |
Grp psych partial hosp 45-50 |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
|
G9685 |
Acute nursing facility care |
Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20 |
Over the next several days, we will provide details of the following additional changes to the Medicare telehealth rules:
- Audio-only telehealth allowed for designated medical services.
- Reimbursement increase for audio-only telephone evaluation and management services.
- Using time spent by a provider, rather than medical decision making, to select the level of evaluation and management services furnished via telehealth.
As always, DaisyBill welcomes questions or concerns from providers regarding the billing and payment landscape as altered by COVID-19. Email info@daisybill.com, and we will address the most frequently asked questions in this space.
Also, refer to our COVID-19 resources page, which includes free videos on billing for telehealth, fee schedule updates, and other news and guidelines relevant to the current situation.
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