April 24, 2020

CMS has broadened access to coverage and payment of all telehealth services due to the COVID-19 Health Emergency.  On March 30, 2020 CMS published the 1135 IFR (Interim Final Rule) Waiver stating Medicare will reimburse for office, hospital, and other visits furnished by telehealth across the country.  The IFR is retroactive to date of service 3/1/2020 on a temporary and emergency basis for the duration of the public health emergency. 

Prior to this waiver, Medicare would only pay for telehealth on a limited basis.  The most notable exception put into place is that patients no longer must travel to a designated facility in order to initiate telehealth services; these services can now be provided from a patient’s home.  Various common communication technologies can be used in good faith, such as FaceTime or Skype for the duration of the emergency.  The HHS Office for Civil Rights (OCR) will waive penalties for HIPAA violations against health care providers serving patients I good faith through these technologies.  However, communication platforms that are not private (i.e., Facebook Live, TikTok, Twitch) are still considered to be HIPAA violations.

Telemedicine visits are defined as real-time, interactive audio, and video communication between the patient and the provider.  Previously, telemedicine visits were only approved for established patients but that requirement has been relaxed and can now include Evaluation and Management services (common office visits) for new patients also. Evaluation and Management levels may be selected based on Total Time spent or MDM.  They can also perform mental health counseling and preventative screenings.  A complete list of services that qualify for telemedicine is located here.

Virtual check-ins are allowable.  These are defined as brief communication technology-based services and can be conducted with a broader range of communication methods including synchronous discussion over a telephone or exchange of information through video or image.  Virtual check-ins can be provided to both new and established patients, and the appropriate HCPCS codes are G2010 or G2012.

E-Visits are generally done through an online patient portal and is considered a non-face to face encounter that is initiated by the patient and may span over a 7-day period. Total time spent must be accurately documented. Codes for these services are 99421-99423 for physician or mid-level provider and HCPCS G2061-G2063 for Qualified Non-physician Healthcare Professional (Clinical Psychologists, Physical, Occupational, and Speech Therapists).

Telephone Visits must be initiated by the patient and cannot be related to an E/M service provided in the previous 7 days nor leading to an E/M service or procedure within the next 24 hours.  Documentation should reflect total time spent.  Report CPT codes 99441-99443.

As time progresses, there may be additional advice given or changes made to the guidelines.  Because they were initiated fairly quickly, it should be viewed as a “work in progress”.  Therefore, everyone should continue to monitor for subsequent changes as they are published.

Robyn McCoart, RHIT

Managing Auditor, Excite Health Partners