CMS Proposes New Telehealth Coverage Codes

In last week’s newsletter, we talked about the new fee changes coming to the Centers for Medicare and Medicaid Services (CMS) physician fee schedule in 2020. Interestingly enough, as the National Law Review first reported, CMS did not receive any requests to add telehealth services to Medicare; rather, they took it upon themselves to include three new telehealth codes that will be covered by the program in the coming year. Typically, when Medicare defines the term “telehealth services,” it (per National Law Review) “refers to a specific set of services practitioners normally furnish in-person, but for which CMS will make payment when they are instead furnished using interactive, real-time telecommunication technology.” Furthermore, the Social Security Act provides five statutory conditions that telehealth providers must meet. As long as those conditions and other standard coverage and payment provisions are met, Medicare will cover the service.

Even though no one requested that more services be added, CMS
proposed three new codes, all of which deal with treatment of opioid use
disorders. HCPCS codes GYYY1-3 are defined as follows; the only thing differing
is the amount of time given to each treatment: “[o]ffice-based
treatment for opioid use disorder, including development of the treatment plan,
care coordination, individual therapy and group therapy and counseling.” Additionally,
the SUPPORT Act, comprehensive legislation signed into law last fall
that takes steps to combat the opioid addiction epidemic, helps these new codes have a greater reach because
the act removed the geographic restriction on telehealth services for patients
diagnosed with substance use disorder (SUD). The act further allows such
services be provided at basically any telehealth originating site, including
the patient’s home. 

The geographic and originating site expansion provisions
from the SUPPORT Act became effective on July 1 of this year. CMS’s proposed
codes would become effective January 1, 2020, if they are added to the list
when the final Medicare rule is published. Currently, CMS remains open to
receiving comments on the proposed rules (the deadline is September 27), as
well as any requests for new services. However, per the National Law Review, “CMS speculate[s] that the vast majority of existing services
that can be appropriately delivered via telehealth are reflected by codes that
are already on the list.” At the moment, in other words, providers should
focus on enhancing telehealth service programs now as Medicare reimbursement
changes continue. In this way, they can save costs and capitalize on
opportunities for more revenue as well as increase clinical quality and patient

Click here to read the National Law Review article on CMS’s proposed coverage of additional telehealth services.


No Comments

Write a Reply or Comment

Your email address will not be published. Required fields are marked *

Thanks !

Thanks for sharing this, you are awesome !