Medicare changes telehealth rules, again: April 30, 2020 interim final rule with comment period (IFC)
CMS released a second IFC with policy changes during the public health emergency. First, although it is titled “with comment period,” CMS is making these changes effective immediately, not after a 60-day comment period) and some changes are retroactive to March. The rule is attached at the bottom of this article, and page numbers correspond to the rule.
Advance practice providers can order, furnish diagnostic tests (page 19)
CMS is adding flexibility about the types of providers (NPs, clinical nurse specialties, PAs, certified nurse midwives) can furnish services directly and incident to their own services, within their state scope of practice. Under current law, only physicians may supervise certain diagnostic tests. CMS is finalizing that during the public health emergency (PHE) advance practice providers may order, furnish and supervise diagnostic tests.
“The interim changes will ensure that these practitioners may order, furnish directly, and supervise the performance of diagnostic tests, subject to applicable state law, during the PHE.”
Hospital outpatient departments new rules (page 53)
If a patient is registered as an outpatient, certain services may be performed via telehealth. Physician supervision must be met, but CMS points out that the vast majority of these services have general physician supervision. When these services are being provided by the hospital, the patient’s home cannot be considered “home” for home health agency purposes.
Hospital based clinics can bill an originating fee (page 55)
Provider based departments (PBD) of a hospital use place of service 19 or 22, outpatient department, on or off campus. When submitting a bill, the charge is split between the professional fee and a facility fee. Up until now, the hospital could not bill a facility fee for telehealth services. There is a statute in the law that prohibited CMS from paying a facility fee to an originating site (home, in this case). But, CMS is considering “home” to be part of the outpatient department of the hospital, while allowing telemedicine during the PHE. The rule says
“…when telehealth services are furnished by a physician or practitioner who ordinarily practices in the hospital outpatient department (HOPD) to a patient who is located at home or other applicable temporary expansion location that has been made provider based to the hospital, we believe it would appropriate to permit the hospital to bill and be paid the originating site facility fee amount for those telehealth services, just as they would have ordinarily done outside of the COVID-19 PHE.”
Use G0463 as the code for the facility fee, when the patient is at home.
Telephone calls, audio only, 99441—99443 will be paid at rates for 99212—99214 (page 137)
These are now considered telehealth services. Continue to use these codes for audio only visits, but the reimbursement will be higher. CMS is not recognizing 98966—98968, which is what they said in their 2020 Final Rule. Continue to use the telephone codes 99441—99443 for E/M services provided through audio only. CMS has increased the reimbursement for those codes. As I read it, this section of the rule refers back to the March 30, 2020 rule and takes the effective date of March 1, 2020. I’ll check with other sources, including MGMA about the effective dates.
CMS has cross-walked the value for 99441—99443 to the values for 99212—99214. CMS has previously said that these phone call codes could be used for new or established patient visits, during the PHE, but there is no crosswalk to new patients.
This change is not that a practice can bill 99202–99215 for phone only services. The change is that the reimbursement for phone only services 99441–99443 will crosswalk to rates 99212–99214.
Times for E/M services codes 99201—99215 (page 182)
In the March rule, CMS published different typical times for E/M services done via telehealth based on time. CMS now says that stakeholders told them that was too confusing. (Really?) Use CPT times.
And some quick items:
- CMS is paying for serology testing for COVID-19
- PT and OT can provide services via telemedicine. This was announced in their 4/29/2020 “COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers.”
- NPs and PAs may now certify and recertify HHA services. (page 76) The CARES Act required CMS to allow NPs and PAs to perform services related to ordering HHA services previously restricted to physicians. The CARES Act gave CMS 6 months from enactment of the law to enact these changes. These are enacted in this rule. NPs, clinical nurse specialists, and PAs may certify eligibility for home health services and review and re-certify the plan of care. Their state must allow this within their scope of practice.