2020 saw a historic expansion of telemedicine by the federal government as an obvious solution, among many, to address the challenges with safely treating patients during a pandemic. On December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) permanently solidified that expansion, even once the COVID-19 public health emergency (PHE) has ended.
In response to the COVID-19 pandemic, CMS rapidly, but only temporarily, expanded Medicare payment for telemedicine in several ways. First, CMS instituted a policy allowing Medicare payment for telemedicine in any location—not just rural locations. Second, CMS instituted a policy allowing telemedicine to be provided even when the patient was not at an approved “originating site.” This allowed reimbursement for telemedicine for patients in their homes, or similar locations. Third, CMS added new Current Procedural Terminology (CPT) codes that would be reimbursable, expanding telemedicine payment to all types of evaluation and management services, as well as others. Finally, CMS increased payment amounts for telemedicine services in a way that would allow physicians and hospitals to receive payment for telemedicine services on par with what they would receive if they services were provided in person. Overall, these changes were a resounding success, appreciated by physicians and patients alike.
As part of the 2021 physician fee schedule, CMS is making some changes permanent or extending them for at least one year (even if the PHE ends prior to the end of 2021). Some of these changes are discussed below.
CMS is making its payment for a number of new CPT codes that were added as part of the COVID-19 response permanent. A full list is available on page 101, table 11. These include:
- Group Psychotherapy (CPT 90853)
- Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT 99334-99335)
- Home Visits, Established Patient (CPT 99347- 99348)
- Cognitive Assessment and Care Planning Services (CPT 99483)
- Visit Complexity Inherent to Certain Office/Outpatient E&Ms (HCPCS G2211)
- Prolonged Services (HCPCS G2212)
- Psychological and Neuropsychological Testing (CPT 96121)
For at least another year, CMS is extending many of the CPT codes that it enabled for telemedicine use during COID-19. A full list is available on page 115, table 13. CMS will continue to study more permanent use of these codes for the coming year. These codes include:
- ED visits
- Certain home visits
- Psychological testing
- Physical and occupational therapy
- Hospital observation care, initial hospital care, and discharge management
- Critical care
- Subsequent and continuing NICU care
CMS is temporarily adding code G2252, which is a global code that will encompass audio-only communications, virtual check ins, although existing virtual check in codes will remain valid as well.
CMS is extending its policy for at least another year, allowing “tele-supervision” for the purposes of incident to services. This means the requirement could be met by the supervising physician (or other practitioner) being immediately available to engage via audio/video technology (excluding audio-only), and would not require real-time presence or observation of the service via interactive audio and video technology throughout the performance of the procedure.
CMS cannot unilaterally change certain statutory telemedicine requirements. For example, the requirements that telemedicine payment is limited to rural areas or when patients are at certain originating sites are statutory requirements. CMS does not have the ability to waive these by rule. Therefore, any changes to these statutory requirements must be addressed by Congress.
If you have any questions about this legal update, please contact a member of the MMM healthcare group.