Medicare Telemedicine Reimbursement Updates in Response to COVID-19

On March 17, 2020, the Centers for Medicare and Medicaid Services (“CMS”) implemented a telehealth waiver (the “Waiver”) under the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020, which allows the U.S. Department of Health and Human Services (“HHS”) to temporarily waive certain Medicare restrictions and requirements regarding the delivery of telehealth services during the coronavirus public health emergency (the “Emergency”). Under the Waiver, CMS is expanding Medicare coverage for telehealth visits.

CMS has issued the following a Waiver Fact Sheet and FAQs.

Summary of Requirements Amended by the Waiver

For the duration of the Emergency, CMS will reimburse health care professionals for telehealth services provided to patients in all parts of the country without requiring that patients travel to a health care facility or other originating site. Similarly, the professional services may be furnished from any setting, including the health care professional’s home. This waives the requirements for originating sites and distant sites that typically apply to Medicare reimbursement for telehealth. Under the Waiver, telehealth visits are considered, and are paid at the same rate as, in-person visits.

For the purposes of Medicare enrollment, if health care professionals furnish Medicare telehealth services from their homes, they must update their Medicare enrollment with their home locations. This can be done by contacting their local Medicare Administrative Contractor’s (“MAC’s”) hotline as detailed in CMS’s Medicare Provider Enrollment Relief FAQs. If a healthcare practitioner reassigns his or her benefits to a clinic/group practice, the clinic/group practice must update its Medicare enrollment with the healthcare professional’s home location. The clinic/group practice can add the individual’s home address to its Medicare enrollment file by reaching out to its MAC’s provider enrollment hotline.

The Waiver also authorizes CMS to waive, on an individual basis, the Medicare requirement that a health care practitioner be licensed in the State in which he or she is practicing, if following conditions are met: (1) the health care practitioner must be enrolled in the Medicare program; (2) the health care practitioner must possess a valid license to practice in the State which relates to his or her Medicare enrollment; (3) the health care practitioner is furnishing services–whether in person or via telehealth–in a State in which the emergency is occurring in order to contribute to relief efforts in his or her professional capacity; and (4) the health care practitioner is not affirmatively excluded from practice in the State or any other State that is part of the Waiver emergency area. Such an individual waiver does not waive State licensure requirements, which continue to apply unless waived by the State. Therefore, in order for a health care practitioner to take advantage of an individual waiver, the State must also waive its licensure requirements, either individually or categorically, for the type of practice for which the health care practitioner is licensed in his or her home State.

Requirements not Amended by the Waiver

• Practitioners authorized to provide telehealth services include:
  • Physicians
  • Nurse practitioners
  • Physician assistants
  • Nurse-midwives
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Clinical psychologists (“CPs”) and clinical social workers (“CSWs”)
    • CPs and CSWs cannot bill Medicare for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services. They cannot bill or get paid for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838.
  • Registered dietitians or nutrition professional

• The CPT and HCPCS codes reimbursable by Medicare are:

Type of Service	Description of Communication	HCPCS/CPT Codes	Patient Relationship with Provider
Medicare Telehealth Visits	The healthcare professional providing the services must use an interactive audio and video telecommunications system that permits real-time communication between the professional and the beneficiary.	Those listed in the current Medicare Physician Fee Schedule.	New Patients (to the extent the Wavier requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted ruing the Emergency. or Established Patients
Virtual Check-In	A brief (5-10 minute) check in with a health care professional via telephone or other telecommunications device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.	HCPCS codes G2010 and G2012	Established Patients Only.
E-Visits	A communication between a patient and a healthcare professional through an online patient portal.	CPT codes: 99421, 99422, 99423 HCPCS codes: G2061, G2062, G2063	Established Patients Only.

 

Guidance Regarding Medicare Cost-Sharing Obligations

Under the Waiver, HHS’s Office of Inspector General (“OIG”) has issued a policy statement assuring that it will not subject physicians and other practitioners to OIG administrative sanctions for arrangements in which a physician or other practitioner reduces or waives cost-sharing obligations (i.e., coinsurance and deductibles) that a beneficiary may owe for telehealth services furnished consistent with the then-applicable coverage and payment rules during the Emergency.

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