New Telehealth Services Proposed in 2020 Physician Fee Schedule

by | Aug 26, 2019 | Blog, Medical Coding | 0 comments

With telemedicine technology, patients can access health care services remotely. According to a white paper by FAIR Health, providers not based in hospitals are rapidly adopting telehealth and the conditions most associated with telehealth use were upper respiratory infection, mood disorders and anxiety or other non-psychotic mental disorders. Medical billing outsourcing is an ideal option for telehealth doctors to get their due reimbursement without delay or denial.

In our earlier blog, we discussed CMS’ plans to expand Telehealth Coverage. In April 2019, CMS finalized the policies to bring innovative telehealth benefit to Medicare Advantage. In its recently proposed 2020 Physician Fee Schedule rule, CMS also lists new telehealth services to be covered under Medicare. The new rule will expand access geographically and plans will have more flexibility in payment models.

In the proposed rule, CMS explains certain clinical benefits of telemedicine such as –

  • Ability to diagnose a medical condition in a patient population without access to clinically appropriate in-person diagnostic services
  • Treatment option for a patient population without access to clinically appropriate in-person treatment options
  • Reduced rate of complications
  • Decreased rate of subsequent diagnostic or therapeutic interventions (for example, due to reduced rate of recurrence of the disease process)
  • Decreased number of future hospitalizations or physician visits
  • More rapid beneficial resolution of the disease process treatment
  • Decreased pain, bleeding, or other quantifiable symptom
  • Reduced recovery time

According to CMS Administrator Seema Verma, “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”

Medicare coverage of telehealth services also relies on five statutory conditions such as –

  • The beneficiary or patient is located in a qualifying rural area;
  • The beneficiary is located at one of eight types of qualifying originating sites;
  • The services are provided by one of ten categories of distant site practitioners eligible to furnish and receive Medicare payment for telehealth services;
  • The beneficiary and distant site practitioner communicate via an interactive audio and video telecommunications system that permits real-time communication between them; and
  • The CPT/HCPCS code for the service itself is named on the list of covered Medicare telehealth services

CMS proposes three HCPCS G-codes

Three HCPCS G-codes that CMS proposed to add to the covered Medicare telehealth service list are:

  • GYYY1: Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month.
  • GYYY2: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month.
  • GYYY3: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (List separately in addition to code for primary procedure).

Submitting requests for adding telehealth services

The public can also submit requests for adding services. CMS can assign any submitted request to add to the list of telehealth services to Category 1 or Category 2. In the calendar year (CY) 2019, CMS has stated that for 2019 and onward, requests will be accepted through February 10. Earlier, the requests to add services to the list had to be submitted and received only till December 31.

While Category 1 refers to services that are similar to professional consultations, office visits, and office psychiatry services that are currently on the list of telehealth services, Category 2 includes services that are not similar to those on the current list of telehealth services. In reviewing requests for Category 1, CMS look for similarities between the requested and existing telehealth services for the roles of, and interactions among, the beneficiary, the physician (or other practitioner) at the distant site and, if necessary, the telepresenter. While reviewing requests for Category 2, an assessment will be done on whether the service is accurately described by the corresponding code when furnished via telehealth and whether the use of a telecommunications system to furnish the service produces demonstrated clinical benefit to the patient. It is also critical that each request to add a service to the list of Medicare telehealth services must include any supporting documentation. An experienced medical coding company will be up to date with such rules and coding guidelines and will provide better documentation.

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