This is part two of our series analyzing telehealth reimbursement rule changes that were announced last week by the Centers for Medicare & Medicaid Services (aka “CMS'' or “Medicare”). Because many states take their cue from Medicare when establishing workers’ comp reimbursements, we’re closely following and reporting on these updates.

Today we will review the following additional changes to Medicare telehealth rules.

• Reimbursement increase for audio-only telephone evaluation and management services
• Audio-only allowed for designated telehealth services

See yesterday’s blog post for our write-up of the following Medicare telehealth changes:

• Waiver of the types of practitioners allowed to furnish telehealth services
• Medical services added to allowed telehealth service list

Audio-Only Telephone Evaluation and Management Reimbursements Increase

In the most recent Medicare and Medicaid IFC: Additional Policy and Regulatory Revisions (CMS-5531 IFC), Medicare acknowledged that audio-only medical services are more prevalent than anticipated. CMS further acknowledged that when many patients are unable to communicate using video technology, providers are forced to use audio-only communications (aka “telephones”) as the only alternative to an in-person or video telehealth visit.

“...stakeholders have informed us that use of audio-only services is more prevalent than we had previously considered, especially because many beneficiaries are not utilizing video-enabled communication technology from their homes. In other words, there are many cases where practitioners would under ordinary circumstances utilize telehealth or in-person visits to evaluate and manage patients’ medical concerns, but are instead using audio-only interactions to manage more complex care.”

Without the appropriate video technology or in-office visits, providers are furnishing patients evaluation and management services via audio-only (telephone) technology. In its latest revision to telehealth rules, the CMS recognized that reimbursements established for these telephone evaluations failed to adequately reimburse providers for the services actually being rendered during these telephone evaluations.

“...we are now recognizing that the intensity of furnishing an audio-only visit to a beneficiary during the unique circumstances of the COVID-19 pandemic is not accurately captured by the valuation of these services we established in the March 31st COVID-19 IFC.”

To adequately reimburse providers for the audio-only services, CMS is increasing payments for telephone evaluation and management visits to match payments for similar office and outpatient visits. Specifically, Medicare is crosswalking CPT codes 99212, 99213, and 99214 to 99441, 99442, and 99443 respectively. The increased reimbursement payments are retroactive to March 1, 2020.

“Given our new understanding that these audio-only services are being furnished primarily as a replacement for care that would otherwise be reported as an in-person or telehealth visit using the office/outpatient E/M codes, we are establishing new RVUs for the telephone E/M services based on crosswalks to the most analogous office/outpatient E/M codes, based on the time requirements for the telephone codes and the times assumed for valuation for purposes of the office/outpatient E/M codes.”

Audio-Only for Designated Telehealth Services

Prior to last week’s change, CMS required providers to furnish all telehealth services using interactive video telecommunications systems. To the extent a patient could not accommodate a video visit, the provider was expected to furnish an audio-only telephone evaluation and to report this audio encounter with time-based telephone codes CPT 99441 through CPT 99443.

For certain behavioral health counseling and educational services  telehealth services, CMS is waiving the requirements for use of interactive video telecommunications systems to furnish the telehealth service. This waiver allows the use of audio-only equipment to furnish services described by the codes.

Unless provided otherwise, other services included on the Medicare telehealth services list must be furnished using, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner.

Below are the designated codes where audio-only is allowed to furnish the medical service. (see designated codes. The CMS will be periodically updating its  List of Telehealth Services.

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 we have published and will publish 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

For more on telehealth rules for Medicare, California health insurers, and California workers’ compensation, look through the free resources available on our COVID-10 page.

FREE TELEHEALTH RESOURCES