Twenty-one states now mandate private insurance coverage, which doubles the number of states over the past two years. Now the Centers for Medicare & Medicaid Services (CMS) has approved several requests by the American Telemedicine Association to expand healthcare services eligible for reimbursement. Coverage has been proposed for medical services, remote testing, and non-face-to-face chronic care services. The new proposals are due to go into effect January 1, 2015. You may view it here. Pages 139-150 are for telehealth services and 170-185 for chronic care management. This notice will be published in the Federal Register of July 11 and open for comment on or before September 2.
Specifically, CMS agreed to add the following services that can be furnished to Medicare beneficiaries under the telehealth benefit:
- Psychotherapy services: CPT codes 90845 (Psychoanalysis); 90846 (family psychotherapy (without the patient present); and 90847 (family psychotherapy (conjoint psychotherapy) (with patient present)
- Prolonged services in the office: CPT codes 99354 (prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (list separately in addition to code for office or other outpatient evaluation and management service); and, 99355 (prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code for prolonged service)
- Annual wellness visit: HCPCS codes G0438 (annual wellness visit; includes a personalized prevention plan of service, initial visit; and, G0439 (annual wellness visit, includes a personalized prevention plan of service, subsequent visit)
In addition, CMS made explicit that Medicare’s telehealth restrictions do not apply to CPT codes 96103 (psychological testing) and 96120 (neuropsychological testing). Therefore, these computerized testing services can be furnished remotely without the physician being present and are billable using the same process as other physicians’ services.
Chronic Care Management
For the first time, CMS is proposing reimbursement criteria for non-face-to-face chronic care management (CCM) services, defined as a unique, covered service designed to pay separately for non-face-to-face care coordination services furnished to Medicare beneficiaries with two or more chronic conditions.
The specific code for this service (tentatively called GXXXI) is defined as “chronic care management services furnished to patients with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; 20 minutes or more; per 30 days”.
A payment rate of $41.92 could be billed no more frequently than once per month per qualified patient.
Eligible CCM services must be furnished with the use of an electronic health record or other health IT or health information exchange platform which includes an electronic care plan that is accessible to all providers within the practice, including being accessible to those who are furnishing care outside of normal business hours and is available to be shared electronically with care team members outside of the practice.
Finally, CMS seeks comment on any changes to the scope of service or billing requirements for CCM services that may be necessary to ensure that the practitioners who bill for these services have the capability to furnish them and that we can appropriately monitor billing for these services.
Here is another article we’d like to share with you on the topic: http://www.fiercehealthit.com/story/cms-proposes-expanded-telehealth-coverage-2015/2014-07-03
This is very encouraging news, and we look forward to developing outcomes for reimbursement!