Medicare Releases REVISED Telehealth Rules - Part 1

May 5, 2020 6 min read

By: Catherine Montgomery

Medicare Releases REVISED Telehealth Rules - Part 1

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:

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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