CMS just released the 2020 final rule with changes to its virtual care codes. The new provision, officially titled “Communication Technology-Based Services,” introduces three new covered Telehealth Services. These changes were proposed as part of the 2020 Physician Fee Schedule earlier this year and continue CMS’ efforts to reduce administrative burden and cover more virtual care services in the Medicare program
In an effort to alleviate administrative burdens, CMS will allow practitioners to obtain a single consent from the patient, covering multiple CTBS services or interprofessional consultation services. The single consent must now be obtained at least once per year, as opposed to the previous requirement of once per service, which is welcome news to industry members. The consent must also include the amount of the patient’s financial responsibility (e.g., co-pay).
Starting January 1, 2020, the following three codes (describing new bundled services for treatment of opioid use disorders) will be available as part of the covered Medicare telehealth services list:
CMS explained that, like certain other non- face-to-face services, the other components of HCPCS codes G2086-G2088 describing care coordination are commonly furnished remotely using telecommunications technology, and do not require the patient to be present in-person with the practitioner when they are furnished. CMS also stated that by considering the face-to-face portion of HCPCS codes G2086-G2088 eligible for telehealth services, the originating site facility fee could be reported, consistent with all other rules, when these services are furnished via telehealth.
With respect to the originating site requirements, recall that, the SUPPORT Act, effective as of July 1, 2019, statutorily removed the geographic limitations for telehealth services furnished to individuals diagnosed with a substance use disorder (SUD) for the purpose of treating the SUD or a co-occurring mental health disorder. The change allows telehealth services for treatment of a diagnosed SUD or co-occurring mental health disorder to be furnished to individuals at any telehealth originating site (other than a renal dialysis facility), including in a patient’s home. No originating site facility fee is paid when the beneficiary’s home is the originating site.
There is a specific process to request additions or deletions from the list of covered telehealth services. Initially, CMS assigns each proposed code to one of two categories. Category 1 is for those services similar to professional consultations, office visits, and office psychiatry services currently on the list of telehealth services. Category 2 is for those services not similar to those on the current list of telehealth services. Proposals that fall into Category 2 undergo a more exacting review, including whether the proposed service will produce demonstrated clinical benefit for patients. When submitting a proposal to request coverage of a new service/code, the proposer should be sure to identify the category to which the service will be assigned, so as to determine the type of clinical and non-clinical supporting documentation that CMS will expect to accompany the submission.
Interested parties need not wait on Congress or CMS to act; anyone may send CMS a request to add existing services (HCPCS codes) to the list of covered Medicare telehealth services. This can include medical specialty societies, individual physicians or practitioners, entrepreneurs, hospitals, state and federal agencies, telehealth companies, vendors, and even patients. Requests may be submitted at any time on an ongoing basis. The requests will be consolidated and considered during the CMS rulemaking cycle.
Instructions for submitting requests can be found on the CMS Telehealth website. Specifically, each request should address the following:
Email your request to Telehealth_Review_Process@cms.hhs.gov and title it “Telehealth Review Process.” Alternatively, you can mail the request to: Division of Practitioner Services, Mail Stop: C4-03-06, Centers for Medicare and Medicaid Services, 7500 Security Boulevard Baltimore, Maryland 21244-1850. Attention: Telehealth Review Process.
The deadline for 2021 PFS consideration is now through February 10, 2020.
Continued expansions in Medicare reimbursement mean providers should make enhancements to telehealth programs now, both for the immediate cost savings and growing opportunities for revenue generation, to say nothing of patient quality and satisfaction. We will continue to monitor CMS for any rule changes or guidance that affect or improve telehealth opportunities.
Join us for a deeper discussion of telemedicine and digital health law issues during Launching and Growing a Direct-to-Consumer Telehealth Service at the CTeL Telehealth Fall Summit in Washington, DC December 4-6, 2019. Learn more and register for the summit here.
For more information on telemedicine, telehealth, virtual care, remote patient monitoring, digital health, and other health innovations, including the team, publications, and representative experience, visit Foley’s Telemedicine & Digital Health Industry Team.