Telehealth Benefits Temporarily Expanded

March 2020 ~

The White House has announced that Medicare administered by CMS will temporarily pay clinicians to provide virtual visits and other telehealth services to beneficiaries.

Telehealth benefits have been expanding over the past two years, but effective March 6, 2020, CMS is further expanding the range of providers allowed to provide virtual care to include more physicians and specialists, nurse practitioners, clinical psychologists, and licensed clinical social workers. Beneficiaries are now able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

Medicare beneficiaries will be able to receive a specific set of services through telehealth including evaluation and management visits (common office visits), mental health counseling and preventive health screenings. According to the fact sheet, this is intended to help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital which puts themselves and others at risk.

Currently, there are three main types of virtual services physicians and other professionals can provide to Medicare beneficiaries: Medicare telehealth visits, virtual check-ins, and e-visits.

MEDICARE TELEHEALTH VISITS

Medicare Telehealth Visits are defined as “a visit with a provider that uses telecommunication systems between a provider and a patient” Common telehealth services include:

• 99201-99215 (office or other outpatient visits)
• G0425–G0427 (Telehealth consultations, emergency department or initial inpatient)
• G0406–G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs)
• A complete list of Medicare telehealth services can be accessed here.

Telehealth visits covered under Medicare are restricted to new or established patients, to the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.

VIRTUAL CHECK-INS

Virtual Check-ins are considered brief (5-10 minutes) meetings with a practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.

Virtual check-ins are limited to previously established patients and the common HCPCS codes used include G2012 and G2010.

E-VISITS

A communication between established patient and their provider through an online patient portal. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. The patient must verbally consent to receive virtual check-in services. The Medicare coinsurance and deductible would apply to these services.

Medicare Part B also pays for E-visits or patient-initiated online evaluation and management conducted via a patient portal. Practitioners who may independently bill Medicare for evaluation and management visits (for instance, physicians and nurse practitioners) can bill the following codes:

• 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes
• 99422: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes
• 99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes.

Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes:

• G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
•  G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
• G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

For more information on the expansion of telehealth services and benefit coverage, see the CMS Fact Sheet and Frequently Asked Questions page.

CPT^® is a registered trademark of the American Medical Association.

Source(s): CMS Press Release; Becker’s Hospital Review; American Medical Association;