The President of the USA, yesterday announced an Emergency Declaration for the whole country.

 

This has given the centers for Medicare & Medicaid (CMS) the opportunity to broadened access to Medicare telehealth services, the purpose being to avoid patients having to travel to a healthcare facility. These policy changes build on the regulatory flexibilities granted under the Emergency Declaration, Medicare has expanded the benefits on a temporary and emergency basis under the 1135 waiver and Coronavirus Preparedness and Response Supplemental Appropriations Act.

 

Telehealth, telemedicine and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, can visit with their doctor from their home without having to go to a doctor’s office or hospital which puts themselves and others at risk.

 

Under this new waiver, Medicare patients will be able to receive a specific set of services through telehealth including:

  • evaluation and management visits (common office visits),
  • Mental health counseling and
  • preventive health screening

 

Medicare will pay for these visits furnished via telehealth across the country and included in patient’s homes.

 

Starting March 6, 2020

 

TYPES OF VIRTUAL SERVICES

 

There are 3 main types of virtual services physicians and other professionals can provide to Medicare beneficiaries: Medicare telehealth visits, virtual check-ins, and e-visits

 

  1. MEDICARE TELEHEALTH VISITS – may be used for office visits, hospital visits and other services that generally occur in

 

  • Effective date March 6, 2020, and for the duration of the COVID-19 Public Emergency
  • These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits
  • The provider must use an interactive audio and/or video telecommunications system that permits real-time communication with the patient
  • It has to be an established patient (HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public emergency)
  • CPTs to use: 99212 allowable $45.45

99213 allowable $75.23

99214 allowable $109.18

99215  allowable $146.87

 

  1. VIRTUAL CHECK-INS – in all areas (not just rural), it is a brief communication service with patient-doctor
    • Telephone, video image, secure text messaging, email or patient portal
    • Has to be initiated by the patient (however doctors may need to educate the patients of the service available before patient initiation)
    • Established patient
    • The communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours
    • The patient must verbally consent to receive the virtual check-in services
    • CPTs: G2012 allowable $12.12, duration 5-10 min

G2010 allowable $14.81, remote evaluation of a recorded video or images submitted by an established pt.

 

  1. E-VISITS- in all types of locations including the patient’s home and all areas (not just rural), it is an online digital evaluation for up to 7 days, cumulative time during the 7 days

 

  • Established patient
  • It’s a Non-face-to-face encounter
  • Use on-line patient portals
  • Has to be patient-initiated, the patient must generate the initial inquiry
  • Patients communication with their doctors without going to the doctor’s office by using the online portal
  • Communication may occur over 7 days
  • CPT’s: 99421 allowable $15.49, time 5-10 min 99422 allowable $31.15, time 11-20 min 99423 allowable $50.31, time 21 min or more