Medicare Releases REVISED Telehealth Rules - Part 1

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:

  1. COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers - Updated 4/30/2020 
  2. List of Telehealth Services
  3. Medicare and Medicaid Coronavirus Waivers & Flexibilities
  4. Medicare and Medicaid IFC: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-5531 IFC) (PDF)
  5. Medicare IFC: Revisions in Response to the COVID-19 Public Health Emergency (CMS-1744-IFC) (PDF)
  6. 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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