CMS issues Interim Rule on use of Telehealth, Remote Patient Monitoring, e-visits, and Virtual Check-Ins during COVID-19
Please see our new post “CMS clarifies use of Remote Patient Monitoring during COVID-19 and further expands Telehealth for Physical Therapists, Occupational Therapists, Speech Pathologists, other practitioners.”
Changes allow expanded use of remote communications technologies to avoid exposure to COVID-19 and reduce risk
In response to urgent requests from healthcare providers and digital health services companies, CMS released a 200+ page Interim Final Rule with comment period (the “Rule”) on March 30, 2020 that eases restrictions around the use of telehealth and other virtual communications technologies to aid response to the COVID-19 public health crisis. The Rule adds reimbursement for over 80 additional services that can now be furnished by telehealth, removes the requirement that Medicare patients have a previously established relationship with the provider billing for telehealth or remote communications services, and allows the “face-to-face” encounters required to initiate some services to be conducted via telehealth.
The following is a summary of some key provisions pertaining to telehealth, remote patient monitoring, and other virtual communications technologies contained in the Rule.
Expanding Telehealth Visits during COVID-19
When Congress passed the CARES Act late last week as its latest response to the coronavirus pandemic, the law included monetary relief for those affected by the crisis. Equally as important for elderly patients and providers, it eliminated Medicare’s antiquated requirement that telehealth visits would only be paid for when they occurred in rural/underserved areas and took place with the patient physically located at an “originating site” such as a medical clinic. Disallowing payment for telehealth treatment delivered to patients in their homes home eliminated the opportunity for many patients to benefit from today’s telehealth capabilities. While this important fix is currently limited to the duration of the National Emergency, many are hopeful that, with adoption by patients and providers forced by virtue of the crisis, broader telehealth coverage will be here to stay.
The Rule dramatically expands the types of typically in-person visits that may now be conducted via telehealth to over 80 additional services added to the 2020 Medicare Telehealth CPT Codes list. These include CPT codes for Emergency Department visits, initial and at discharge Skilled Nursing Facility visits, psychological testing, and therapy visits.
Unfortunately, physical therapists, occupational therapists, and speech pathologists are not currently included in the statutory list of providers eligible to conduct telehealth visits. While a number of therapy-related CPT codes were added to the Medicare Telehealth list, the Rule makes clear that, by statute enacted years ago, PTs, OTs, and STs are not eligible to be paid for providing these services via telehealth. Instead, these services must be provided by an “eligible practitioner” which might include a Nurse Practitioner, a Physician Assistant, a Clinical Psychologist, and the like.
Importantly, RHCs and FQHCs will now receive standalone reimbursement for telehealth visits for both new and established patients. CMS specifies that patient consent for these visits can be obtained by auxiliary personnel at the time of service.
Remote Patient Monitoring to help keep COVID-19 patients at home
The interim Rule brings long-awaited clarification by CMS as to what types of patients are eligible to receive RPM services under the CPT codes introduced in 2018. We now know with certainty that remote patient monitoring is not limited to use with Medicare patients suffering from one or more chronic conditions, but may instead be used to manage the care of patients with a post-surgical or acute condition – including but not limited to COVID-19. Unlike many of the other provisions in the Rule, this clarification seems to extend beyond the timeline dictated by the National Emergency.
The Rule further clarified that patient consent must be obtained for RPM services, though it went on to indicate that, during the National Emergency, this consent could be obtained at the time of initial service and should be documented in the medical record. Finally, the Rule establishes that RPM services can be ordered by a provider for new patients without requiring a pre-existing provider relationship.
Virtual Check-ins and e-Visits
CMS states that, on an interim basis during the National Emergency, Virtual Check-ins (HCPCS 2012), Remote Evaluation of Images (HCPCS 2010), and e-Visits can be furnished to both new and established patients, and consent can be obtained at the time of service by auxiliary staff and renewed on an annual basis as necessary.
As under the 2020 Medicare Physician Fee Schedule, e-Visits may be performed by either a physician (CPT Codes 99421-99423) or a non-physician qualified health care provider who is unable to bill E/M codes (HCPCS Codes G2061-G2063). CMS specifically states that licensed clinical social worker services, clinical psychologist services, physical therapist services, occupational therapist services, or speech language pathologist services may bill these codes.
Telephone-Only Reimbursement
The Rule reinforces that Medicare will not pay for telehealth services unless those services are delivered via two-way live interactive audio-visual means. However, during the public health emergency, CMS understands there is value in reimbursing for other non-face-to-face codes that exist outside of Medicare’s definition of telehealth (e.g., remote patient monitoring). In the Rule, CMS has decided to re-evaluate its reimbursement policy for several “telephone evaluation and management (E/M) services” introduced by CMS in the 2008 Medicare Physician Fee Schedule. These codes include:
Non-physician Codes
These codes describe assessment and management services performed by practitioners who cannot separately bill for E/Ms. These services may be furnished by, among others, LCSWs, clinical psychologists, and physical therapists, occupational therapists, and speech language pathologists when the visit pertains to a service that falls within the benefit category of those practitioners. To facilitate billing of these services by therapists, CMS has designated these codes as CTBS “sometimes therapy” services that would require the private practice occupational therapist, physical therapist, and speech-language pathologist to include the corresponding GO, GP, or GN therapy modifier on claims for these services.
CPT 98966. Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
CPT 98967. Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
CPT 98968. Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
Physician Codes
CPT 99441. Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
CPT 99442. Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
CPT 99443. Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion