Telehealth gets a Boost in 2015 Medicare Physician Fee Schedule

by | Published on Dec 15, 2014 | Resources, Articles | 0 comments

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The Centers for Medicare and Medicaid (CMS) has added seven new payment codes in their 2015 physician fee schedule for telehealth services. This is a big breakthrough for the telehealth service industry which has been pushing for these changes since a few years. The 7 new telehealth services added are:

  • Psychotherapy
  • Psychoanalysis
  • Prolonged office visits
  • Annual wellness visit and related matters
  • Remote chronic care management
  • Remote patient monitoring

The new CPT codes and HCPCS codes for these services as spelled out in the 1200 final rules are as follows

  • CPT 99490 – for paying remote chronic care management with a monthly unadjusted non-facility fee of $42.60
  • CPT 99091 –  for reimbursement for remote patient monitoring of chronic conditions through a monthly unadjusted non-facility fee of $56.92
  • CPT 90845, 90846 and 90847 – psychotherapy services
  • CPT 99354 and 99355 – prolonged evaluation and management services
  • HCPCS G0438 and G0439 – annual wellness visits

With the new rules, primary care doctors can also bill Medicare $40 per patient each month for care coordination of patients with at least two chronic conditions including heart failure and diabetes.

Rising Importance of the Teleconsultation in Clinical Medicine

Medical service provided without the physical presence of a physician – this is telemedicine in its simplest form. The rising importance of telehealth shows the major role that telemedicine can play in cost reduction as well as increased quality, access, and overall satisfaction. The tele-consultation allows physicians to interact with patients more efficiently and effectively as well as serve to more patients than in the traditional encounters. It ensures that patients get attention faster and in a more convenient way without any distance limitation, whenever they require care.

Telemedicine can be used for remote patient monitoring, medical education, and primary care services. The usage of technology allows in greater coordination and management of care along with reduced hospital visits. Another advantage of telemedicine is that it can be used in rural communities where there is a shortage of physicians, where care can be given without prohibitive expenses or difficult transportation arrangements.

Future of Telemedicine

However, according to one report, Politico says that all the news is not telemedicine friendly. Some stakeholders wanted the removal of a provision that requires patients to be in a rural location to receive telemedicine billing service, but CMS did not comply with this request.

CMS will continue to review requests to add billable telemedicine services in Medicare and requests for potential new services in 2016 are due by the end of the year. Provided a number of conditions are met, the chronic care management codes will allow providers to bill for non-face-to-face encounters with patients with multiple chronic conditions.

The addition of new codes shows that the federal government is contemplating a bigger role for telemedicine as a regular part of health care. Physicians practicing telemedicine can expect to see an increase in patient volume, and it is important for the services delivered to be billed or coded correctly for appropriate and timely reimbursement. A professional medical billing company can provide medical coding and billing solutions for telehealth including accurate CPT/HCPCS codes, modifiers, and adherence to industry guidelines.

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