On April 30, 2020, CMS announced new regulatory waivers and rule changes in order to help providers address the COVID-19 public health emergency. The waivers touch on many different areas of health care and contain many significant telehealth provisions. The changes remain consistent with the agency’s pledge to expand beneficiaries’ access to telehealth services.
The Specific Telehealth Provisions Are:
- Boost Reimbursement: CMS is increasing its payments for telephone evaluation and management visits (CPT codes 99441 – 99443) to be the equivalent of Medicare payments for office/outpatient visits. The payments are retroactive to March 1, 2020.
- Expand Reimbursement to More Provider Types and Clinical Sites: The waiver expands the types of health care professionals who can bill Medicare for their professional services. Now, providers such as physical therapists, occupational therapists and speech-language pathologists can receive payment for Medicare telehealth services.
Hospitals may bill for the telehealth originating site facility fee when telehealth services are furnished remotely by hospital-based practitioners to Medicare patients who are registered as hospital outpatients, including when the patient is at home and when the home is serving as a temporary provider-based department of the hospital. Both the telehealth professional fee and originating site fee are paid under the Medicare Physician Fee Schedule.
Additionally, as mandated by the CARES Act, rural health clinics and federally qualified health centers will be reimbursed for telehealth services as these locations are now deemed acceptable distant sites.
- Increased Audio-Only Telehealth for Certain Services: The waiver increases the number of services allowed to be furnished by audio-only technology. The services are described by codes for behavioral health counseling and educational services linked here.
- Look for New Telehealth Services: CMS intends to add new types of telehealth services on a sub-regulatory basis through guidance, instead of the formal notice-and-comment process. In theory, this will significantly speed up the process of adding services to the CMS-approved list of services that may be delivered via telehealth.
Cautions:
- CMS appears to remain committed to the expansion of virtual care – minimally for the period of the declared public emergency. Of course, given the uncertainties related to COVID-19 and the favorable outlook with respect to telehealth expansion, we anticipate there will be a significant push to retain at least some degree of this expansion.
- Providers should be mindful that these additional flexibilities are specific to Medicare reimbursement for telehealth services.
- These flexibilities do not negate state-specific professional practice requirements for the provision of telehealth/telemedicine, nor do they negate DEA requirements (under the DEA’s own emergency exception) for the use of synchronous audio/visual technology in relation to the prescription of controlled substances.
If you have additional questions, please contact:
- Chris Eades at (317) 977-1460 or ceades@hallrender.com;
- Regan Tankersley at (317) 977-1445 or rtankersley@hallrender.com;
- Scott Geboy at (414) 721-0451 or sgeboy@hallrender.com;
- Mike Batt at (317) 977-1417 or mbatt@hallrender.com;
- Abby Kaericher at (202) 780-2989 or akaericher@hallrender.com; or
- Your regular Hall Render attorney.
Hall Render’s attorneys and professionals continue to maintain the most up-to-date information and resources at our COVID-19 Resource page, through our 24/7 COVID‑19 Hotline at (317) 429-3900 or by contacting your regular Hall Render attorney.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
