Telehealth: Medicare Finalizes New Services for 2020 in Physician Fee Schedule

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

Consent for Communication Technology-Based Services (CTBS)

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).

New Telehealth Services

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:

1. HCPCS code G2086: 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.
2. HCPCS code G2087: 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.
3. HCPCS code G2088: 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).

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.

Como solicitar serviços adicionais de telessaúde do Medicare

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:

• Name(s), address, and contact information of the requestor.
• Os códigos HCPCS que descrevem os serviços propostos para adição ou exclusão da lista de serviços de telessaúde do Medicare. Se o solicitante não souber o código HCPCS aplicável, a solicitação deve incluir uma descrição dos serviços prestados durante a sessão de telessaúde.
• Uma descrição do(s) tipo(s) de profissional(is) médico(s) que presta(m) o serviço de telessaúde no local distante.
• Uma discussão detalhada das razões pelas quais o serviço proposto deve ser adicionado à definição de serviço de telessaúde do Medicare.
• Uma explicação sobre o motivo pelo qual o serviço solicitado não pode ser faturado no âmbito atual dos serviços de telessaúde, por exemplo, a razão pela qual os códigos HCPCS atualmente na lista de serviços de telessaúde do Medicare não seriam adequados para o faturamento do serviço solicitado.
• Evidence that supports adding the service(s) to the list on either a Category 1 or Category 2 basis as explained in the section on the CMS webpage labeled “CMS Criteria for Submitted Requests.”

Email your request to [email protected] 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.

Quer saber mais?

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.

Para obter mais informações sobre telemedicina, telessaúde, atendimento virtual, monitoramento remoto de pacientes, saúde digital e outras inovações na área da saúde, incluindo a equipa, publicações e experiências representativas, visite a Equipa de Telemedicina e Saúde Digital da Foley.