Our medical billing company stays up-to-date on CMS guidelines and reporting requirements. The proposed 2021 Physician Fee Schedule rule was released by the Centers for Medicare and Medicaid Services (CMS) on August 3. The rule contains several important telehealth policy proposals, which are listed below:

  • Change in definition of direct supervision: CMS proposes to change the definition of direct supervision to allow the supervising physician to meet direct supervision requirements while remote and engage using real-time, interactive audio-video technology (excluding telephone that does not also include video) through Dec. 31, 2021. This change can greatly increase physician leverage and result in new opportunities for incident-to billing.

    Currently, direct supervision requires the physician to be physically present in the office suite and immediately available to provide assistance and direction throughout the performance of the procedure. As this requires the billing clinician to be present on site, it is difficult for the billing clinician to directly supervise services provided via telehealth incident-to their professional services by auxiliary personnel.

    The new definition of direct supervision is based on the belief that services provided incident to the professional services of an eligible distant site clinician could be reported when they meet direct supervision requirements at both the originating and distant site through the virtual presence of the billing practitioner. However, the period for which this change is valid is limited as widespread virtual direct supervision may not be safe for certain clinical situations (www.foley.com).

  • Addition of services to Medicare telehealth services list: The nine new HCPCS codes that CMS is proposing for permanent addition to the Medicare telehealth list include:

    90853 – Group Psychotherapy
    99334, 99335 – Domiciliary, Rest Home, or Custodial Care Services
    99347, 99248 – Home Visits
    GPC1X – Visit Complexity Associated with Certain Office/Outpatient E/Ms
    99XXX – Prolonged Services
    99483 – Cognitive Assessment and Care Planning Services
    96121- Psychological and Neuropsychological Testing

    CMS is proposing to create a temporary category of criteria for adding services to the list of Medicare telehealth services. The services that are meant to be used during the COVID-19 PHE and will remain on the list temporarily are:

    99336, 99337 – Domiciliary, Rest Home, or Custodial Care Services
    99349, 99350 – Home Visits, Established Patient
    99281, 99282, 99283 – Emergency Department Visits
    99315, 99316 – Nursing Facilities Discharge Day Management
    96130, 96131, 96132, 96133 – Psychological and Neuropsychological Testing

  • Additional guidance on community-technology based services (CTBS): CMS defines communication technology-based services (CTBS) as services that can be furnished via telecommunications technology but that are not considered Medicare telehealth services. CMS proposed to allow HCPCS codes G2061-G2063 to be billed by licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists who bill Medicare directly for their services when the service furnished falls within the scope of these practitioners’ benefit categories. CMS is proposing to adopt this policy on a permanent basis. CMS is proposing two additional HCPCS Level II G codes that can be billed by certain nonphysician practitioners who cannot independently bill for E/M services:

    G20X0 – Remote assessment 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 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment.

    G20X2 – Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

    To facilitate billing of CTBS by therapists, CMS proposes to designate HCPCS codes G20X0, G20X2, G2061, G2062, and G2063 as “sometimes therapy” services. When billed by a private practice PT, OT, or SLP, the codes would need to include the corresponding GO, GP, or GN therapy modifier to indicate that the CTB are furnished as therapy services furnished under an OT, PT, or SLP plan of care.

Comments on the proposed rule may be submitted to CMS by Oct. 5, 2020.

If implemented, the proposed new changes would expand the use of telehealth technologies among Medicare beneficiaries. Outsourcing medical billing can help clinicians code and bill RPM services correctly in accordance with Medicare requirements.