Yesterday, the Centers for Medicare & Medicaid Services (“CMS”) expanded Medicare coverage for telehealth services in response to COVID-19.
Previously, Medicare coverage of telehealth services was extremely limited; CMS only provided reimbursement for services rendered in a certain geographic area when the patient was located at a particular originating site. However, to limit the spread of COVID-19 and ensure those who may be infected receive prompt medical care, Medicare will reimburse the following telehealth services retroactively to an effective date of March 6, 2020: (i) telehealth visits; (ii) virtual check-ins; and (iii) e-visits.
All telehealth visits furnished to beneficiaries in any healthcare facility or in their home will be reimbursed at the same rate as in-person visits. Providers eligible to provide telehealth services include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals. These providers must continue to use an interactive, real-time, audio and video telecommunications system.
The Department of Health and Human Services will not conduct audits to confirm a prior bona fide provider-patient relationship exists for telehealth related claims submitted during this public emergency. This waiver is due in part to the understanding that unnecessary traveling should be limited to prevent the spread of COVID-19.
Virtual check-ins are brief communication services with practitioners provided through certain communication technology modalities, such as telephone, secure text messaging, or e-mail. Although the virtual check-in services can be provided to patients in any location, there must be an already established bona fide provider-patient relationship. Additionally, the check-ins must not be related to a medical visit within the previous seven days and must not lead to a medical visit within the following twenty-four hours. Furthermore, the patient must verbally consent to the check-in.
CMS provides the following two HCPCS codes that may be used when submitting claims to Medicare for virtual check-in services:
- HCPCS Code G2012 for virtual check-ins by qualified health care professionals who can report evaluation and management services provided to an established patient, not originating from a related e/m service provided within the previous seven days nor leading to an e/m service or procedure within the next twenty-four hours or soonest available appointment; 5-10 minutes of medical discussion.
- HCPCS Code G2010 for remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within twenty-four business hours, not originating from a related e/m service provided within the previous seven days nor leading to an e/m service or procedure within the next twenty-four hours or soonest available appointment.
Like telehealth visits and virtual check-ins, e-visits may also be provided in all areas. E-visits are non-face-to-face patient-initiated communications with a provider through an online patient portal. For these services to be reimbursed by Medicare, there must be an already established bona fide provider-patient relationship and the patient must generate the initial inquiry and communication. Additionally, the patient must verbally consent to receive virtual check-in services. The following HCPCS and CPT codes may be used when submitting claims to Medicare for e-visits:
- HCPCS Code G2061 for qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the seven days; 5-10 minutes.
- HCPCS Code G2062 for qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the seven days; 11-20 minutes.
- HCPCS Code G2063 for qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the seven days; 21 or more minutes.
- CPT Code 99421 for an online digital evaluation and management service for an established patient for up to seven days, cumulative time during the seven days; 5-10 minutes.
- CPT Code 99422 for an online digital evaluation and management service for an established patient for up to seven days, cumulative time during the seven days; 11-20 minutes.
- CPT Code 99423 for an online digital evaluation and management service for an established patient for up to seven days, cumulative time during the seven days; 21 or more minutes.
These new coverage and payment rules are effective immediately. The Office of Inspector General (“OIG”) also released a policy statement that health care providers will not face any sanctions for reducing or waiving co-insurance and deductibles for telehealth services provided during this time. These services must be rendered consistent with the applicable coverage and payment rules. In ordinary circumstances, the waiver of such cost-sharing amounts may implicate certain Federal and state statutes. However, the OIG will not impose administrative sanctions at this time due to the nationwide public health emergency. Frier Levitt will closely monitor any updates on how this waiver affects state law provisions.
For more information regarding the requirements for these new HCPCS or CPT codes or the expansion of telehealth services during this national emergency, contact Frier Levitt.
