The Centers for Medicare and Medicaid Services (CMS) has expanded Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act, enabling Medicare beneficiaries to receive a wider range of healthcare services without having to travel to a healthcare facility.
This action is part of the CMS response to the 2019 novel coronavirus (COVID-19).
Prior to this announcement, CMS only paid clinicians for telehealth services in certain circumstances. For example, the beneficiary receiving the services had to live in a rural area and travel to a local medical facility to receive telehealth services from a provider in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.
Over the last 2 years, Medicare expanded the ability for clinicians to have brief check-ins with their patients through phone, video chat, and online patient portals, referred to as “virtual check-ins.” With the expansion of telehealth benefits, Medicare beneficiaries will now be able to receive telehealth services in any healthcare facility, including a physician’s office, hospital, nursing home, and rural health clinic, as well as from their homes.
In addition, patients will now be able to access their healthcare providers using a wider range of communication tools, including telephones that have audio and video capabilities, making it easier for beneficiaries and providers to connect.
Clinicians can bill immediately for dates of service starting March 6, 2020. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. Medicare coinsurance and deductible still apply for these services. In addition, the HHS Office of Inspector General is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
The Fact Sheet on this announcement is available here.
Frequently Asked Questions on this announcement are available here.
Information from the American Academy of Orthopaedic Surgeons on telemedicine coding can be found here.