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COVID-19 Telehealth Coverage Policies

As things rapidly develop regarding what we know about COVID-19, policies around telehealth have also been evolving alongside of it.  We’ve been tracking those updates as they become available. This a living document that could change frequently as new information and new policies become available/are enacted.   

This is a summary of changes the Centers for Medicare and Medicaid Services (CMS) has made to telehealth policy for Fee-for-Service Medicare.

 

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Medicare Fee-for-Service Telehealth Coverage

Most of the changes discussed below will end when the federal Public Health Emergency (PHE) expires.  It is currently set to expire on April 20, 2021, unless it is declared over by the Secretary before then or renewed.  However, Department of Health and Human Services (HHS) sent a letter to governors indicating their plans to renew the PHE until the end of 2021.

General Medicare Telehealth Policies During COVID-19

Subject Area Policy During COVID-19 Policy for FQHC/RHC
Geographic/Site Location for Patient No geographic restrictions, patient allowed to be in home during telehealth interaction No geographic restrictions, patient allowed to be in home during telehealth interaction
Location of Provider Provider able to provide services when at home, need not put home address on claim Provider able to provide services when at home
Modality Live Video. Audio-only telephone will be allowed for certain E/M services and behavioral health counseling and educational services. Eligible CPT codes for audio-only delivery are identified in CMS’ Telehealth Service PHE list.  Other modalities allowed for Communications Based Services. Live Video. Phone will be allowed for codes that are audio-only telephone E/M services and behavioral health counseling and educational services. Other modalities allowed for Communications Based Services.
Type of Provider All health care professionals may bill Medicare for their professional services. Temporarily added to list of eligible providers by CARES Act.
Services Approximately 240 different codes available for reimbursement if provided via telehealth.  List available here.  According to CMS finalized 2021 physician fee schedule (PFS) some codes were made permanent, and others will be reimbursable through the end of the year in which the PHE ends.  See CCHP’s analysis of the CY 2021 PFS here. Can only provide the services on this list via telehealth and be reimbursed by Medicare.
Amount of Reimbursement Same as would receive if it had been provided in-person (Fee-for-service rate). Some rates for telephone visits have been increased. $92.03
Modifiers Per the final interim rule, providers are allowed to report POS code that would have been reported had the service been furnished in person so that providers can receive the appropriate facility or non-facility rate and use the modifier “95” to indicate the service took place through telehealth.  If providers wish to continue to use POS code 02, they may and it pays the facility rate.   For services delivered 1/27/20–6/30/20

RHCs:
  Use G2025 with CG modifier. 95 modifier can be appended, but is not required.

FQHCs:
  Must report 3 HCPCS/CPT codes: (1) the PPS specific payment code; (2) the HCPCS/CPT code that describes the service with the 95 modifier; (3) G2025 with modifier 95

Beginning July 1, 2020


FQHCs/RHCs:
 Only submit G2025.  RHCs should no longer use CG modifier.

Other Medicare Policies Related to Telehealth During COVID-19

Subject Area Policy During COVID-19
End State Renal Disease & Home Dialysis Patients CMS exercising enforcement discretion on requirement that home dialysis patients receiving services via telehealth must have a monthly face-to-face, non-telehealth encounter in the first initial three months of home dialysis and after the first initial three months, at least once every three consecutive months. ESRD clinicians no longer must have one “hands on” visit/month for current required examination of vascular access site.  Clinicians will not have to meet the National Coverage Determination or Local Coverage Determination of face-to-face visit for evaluations and assessments during this public health emergency.
Nursing Homes CMS waiving requirement that physicians and non-physician practitioners perform in-person visit for nursing home residents and if appropriate, allow them to be done via telehealth.
Hospice During an emergency period, the Secretary may allow telehealth to meet the requirement that a hospice physician or nurse practitioner must conduct a face-to-face encounter to determine continued eligibility for hospice care.
Frequency Limitations The pre-COVID-19 frequency limitations on subsequent in-patient visit (once every three days), subsequent SNF visit (once every 30 days), and critical care consult (once a day) were removed. 
Supervision Physician supervision may be provided using live video. For other supervision changes, see FAQ Billing Guide
Stark Laws CMS is allowing certain waivers:  hospitals and other health care providers can pay above or below fair market value to rent equipment or receive services from physicians; health care providers can support each other financially to ensure continuity of health care operations; and others.  See FAQ Billing Guide
Provider Home Address on Claim Provider need not put their home address on the claim if they conducted a telehealth visit while at home.
Out-of-Pocket Costs/Co-Pays Still applies, but the OIG is providing health care providers flexibility to reduce or waive fees. COVID-19 testing should be waived.
Prior Existing Relationship Can be to new and established patients.
Hospitals & Originating Site Fee Hospitals can bill an originating site fee when the patient is at home. See FAQ Billing Guide.  
Hospital-Only Remote Outpatient Therapy & Education Services Hospitals may provide through telecommunication technology behavioral health and education services furnished by hospital-employed counselors or other health professionals who cannot bill Medicare directly. Includes partial hospitalization services and can be furnished when the beneficiary is the home. See FAQ Billing Guide.
Opioid Treatment Programs Counseling and therapy services can be provided by telephone only in cases where the beneficiary does not have access to live video.  Periodic assessments can be done via live video and telephone if beneficiary does not have access to live video.

You can see more resources on Federal telehealth COVID policies in our Policy Finder

Other Medicare Policies

Licensing

Temporarily waive Medicare and Medicaid requirements to be licensed in the patient state if they are enrolled in Medicare, have valid license in the state which relates to Medicare enrollment, in furnishing services in the state where the emergency is occurring, and not excluded from practicing in that state or any other state that is part of the emergency. State requirements will still apply.

Medicare Advantage

Existing Telehealth Policy Pre-COVID-19 Policy Change in Response to COVID-19 What Can Be Covered
Medicare Advantage (MA) plans have the flexibility to have more expansive telehealth policies related to types of services covered, where those services can take place (no geographic or site limitations), modality used. Still limits the types of providers reimbursed. Medicare Advantage Organizations were informed by CMS that if they wish to expand coverage of telehealth services beyond what has already been approved by CMS, they will exercise its enforcement discretion until it is determined that it is no longer necessary in conjunction with the COVID-19 outbreak. (CMS Memo) MA plans have some flexibility to expand their coverage of telehealth beyond what they currently do. What is covered will depend on what each plan decides to do. NOTE: MA plans do not have to provide these more expansive telehealth services. They are only required to provide what is covered by Fee-for-Service.


Other Technology-Enabled Services

Existing Telehealth Policy Pre-COVID-19 Policy Change in Response to COVID-19 What Can Be Covered
Virtual Check-In Codes
G2010, G2012*Can be done synchronously and asynchronously and telephone can be used
Other providers such as PTs, OTs and speech language pathologists may bill these codes as well as G2061-G2063. In the 2021 PFS, this was made permanent.  

Can be provided to both new and established patients.  They were previously limited to established patients.

Virtual check-in codes do not have geographic or site restrictions attached so they can be used to engage with patients, but the reimbursement amount for these codes is low and are only meant to act as quick check-ins with patients that do not last more than a few minutes.
Interprofessional Telephone/Internet/EHR Consultations (eConsult) *
99446, 99447, 99448, 99449, 99451, 99452 
No changes eConsult allows a provider-to-provider consultation. Pays both providers, but check definition for the time needed for each code.
Remote monitoring services: *

Chronic Care Management
Transitional Care Management
Remote Physiologic Monitoring
Principal Care Management

Remote patient monitoring can be provided to new and established patients. After the PHE, RPM will only be available for established patients according to the 2021 PFS. These services are not considered “telehealth” services and were never subject to telehealth limitations. They do have other factors that limit how they can be used so make sure you check the definition for the codes.
Online Digital Evaluation (E-*Visit) – G2061-2063
Online medical Evaluations – 99421-99423
Can be delivered by clinical social workers, physical therapists, occupational therapists and speech language pathologists. These services are not considered “telehealth” services and were never subject to telehealth limitations.
Telephone E/M Services Added by Interim Final Rule. According to 2021 PFS, after the PHE CMS will cease reimbursement for 99441-99443 and other audio-only reimbursement, but will instead reimburse for G2252 which includes 11-20 min. of medical discussion. 98966-98968; 99441-99443.  After PHE, coverage for these codes will cease, and only coverage for G2252 will be available.

Other Medicaid Policies

Existing Telehealth Policy Pre-COVID-19 Policy Change in Response to COVID-19 What Can Be Covered
Telehealth reimbursement policies vary from state to state. If the State Medicaid program has managed care, telehealth reimbursement can vary from plan-to-plan. Look up your state in our Policy Finder. A Medicaid FAQ was issued stating that state Medicaid programs have broad authority to utilize telehealth within their Medicaid programs including using telehealth or telephonic consultations in place of typical face-to-face requirements when certain conditions are met. States would have to use the Appendix K process for this.  See CCHP’s tracking of state changes here.

As noted above, licensure requirements were waived for Medicaid, though state requirements would still apply.

Still developing. Some states have encouraged providers and health plans to utilize telehealth more broadly to provide services but for many states the policies continue to be developing as they navigate this situation.

Other Federal Actions

Drug Enforcement Agency (DEA)

The declaration of the national emergency enacted one of the exceptions to the Ryan Haight Act for telehealth (telemedicine as it is referred to in the Act).

For as long as the Secretary’s designation of a public health emergency remains in effect, DEA-registered practitioners may issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided all of the following conditions are met:

  • The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice
  • The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system.
  • The practitioner is acting in accordance with applicable Federal and State law.

Source

Health Insurance Portability & Accountability Act (HIPPA)

A change was made:

“Effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.”

Source

It should be noted that many states do have laws and regulations regarding health information and what is required to protect and secure it. This will likely not impact those state laws and regulations. A separate state action will be necessary.

OCR Guidance on HIPPA

Private Insurers

Existing Telehealth Policy Pre-COVID-19 Policy Change in Response to COVID-19 What Can Be Covered
Coverage varied from payer-to-payer, depending on the plan. Several health plans announced that they will make telehealth more widely available or offering telehealth services for free for a certain period of time. Some of the announcements have come from Aetna, Cigna and BlueShield BlueCross. However, some of these policies have expired. Check with health plan for their updated policies. Commercial payer policies varied during the pandemic and some exceptions have already expired in 2020. Check with your health plan for their updated policies.

FQHC’s / RHC’s: How Can I Use Telehealth?

The Centers for Medicare and Medicaid Services (CMS) issued FAQs and billing guidance that includes the expanded flexibilities given to Federally Qualified Health Centers (FHQCs) and Rural Health Clinics (RHCs) during the COVID-19 Public Health Emergency (PHE) crisis. The CARES Act, HR 748, allowed FQHCs and RHCs to utilize telehealth and act as distant site providers during a PHE. See our fact sheet summarizing the guidance here.

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