CMS also proposed new services to the Medicare telehealth list and proposed a new category for adding telehealth services. Category 3 telehealth services were added to the Medicare telehealth list during the COVID-19 public health emergency and have not yet been supported through documentation to illustrate clinical benefit, which is necessary to be added under Category 2 telehealth services.
Among the proposed additions to the Medicare Telehealth Services List under Category 1 (similar to currently listed Medicare telehealth services): more complex visits that allow offices to bill for more advanced office/outpatient E/M codes (GPC1X), group psychotherapy (90853), neurobehavioral status exam (96121), prolonged office or other outpatient E/M services (99XXX), assessment and care planning for patients with cognitive impairment (99483), and domiciliary, rest home, or custodial care services (99335) and home visits (99347 and 99348). With regard to home visits, CMS explained adding domiciliary/home visits that contain the same elements and similar descriptors to the office/outpatient E/M visits allows for sufficient justification for being added to Category 1. Also, CMS clarified that because Medicare telehealth rules generally do not allow for patient homes to be originating sites, these services would be billed when furnished as telehealth services only for treatment of a substance use disorder or co-occurring mental health disorder.
Category 3 telehealth services would remain on the list through the calendar year in which the public health emergency ends, arguably giving the community enough time to submit documentation support of clinical benefit under category 2. These include domiciliary, rest home, or custodial care services for established patients (99336, 99337), emergency department visits (99281, 99282, 99283), nursing facilities discharge day management (99315, 99316), psychological and neuropsychological testing (96130, 96131, 96132, and 96133), and home visits for established patients (99349, 99350) for established patients. CMS is specifically soliciting comments on those category 3 services and the services that it had not added.
Additionally, CMS proposed to extend its policy to allow providers to use interactive audio/video real-time communications technology to provide virtual direct supervision through the later of the end of the calendar year in which the public health emergency ends or December 31, 2021. CMS solicited comments on whether any guardrails for this flexibility should be adopted to ensure patient safety as well as any restrictions to prevent fraud or inappropriate use.
CMS also clarified that Medicare telehealth rules (pertaining to the originating site, provider, modality, reimbursement code restrictions) do not apply when the beneficiary and the practitioner are in the same location even if audio/video technology assists in furnishing a service.
Finally, CMS confirmed that audio-only telephone evaluation and management services will not be reimbursable after the COVID-19 public health emergency. CMS is seeking comment on whether CMS should develop coding and payment for a service similar to the virtual check-in but for a longer unit of time and subsequently with a higher value. If so, CMS is seeking input from the public on the duration of the services, the resources for both work and practice expense associated with furnishing such services, and whether this should be a provisional policy to remain in effect until a year after the end of the PHE for the COVID-19 pandemic or if it should be PFS payment policy permanently.
CMS is requesting comments by October 5, 2020, and the final rule expected in the fall will be effective January 1, 2021.