Telemedicine/Telehealth/eVisit Fact Sheet #telemedicine #telehealth #digitalhealth #medicare #CMS #hippa

Originating Site:

• Physician and practitioner offices • Hospitals • Critical Access Hospitals (CAHs) • Rural Health Clinics • Federally Qualified Health Centers • Hospital-based or CAH-based Renal Dialysis Centers (including satellites) • Skilled Nursing Facilities (SNFs) • Community Mental Health Centers (CMHCs) • Renal Dialysis Facilities* • Homes of beneficiaries with End Stage Renal Disease (ESRD) getting home dialysis* • Mobile Stroke Units* • Home of Patient receiving treatment for SUD/Opioid Abuse and cooccurring mental health disorders* (*Geographic limit may not apply to these facilities in specific circumstances).

Distant Site:

Medicare does not provide a definition of distant site. CMS has stated that providers cannot be located out of the country when providing the service via telehealth.

Those providers include: • Physicians • Nurse practitioners (NPs) • Physician assistants (PAs) • Nurse-midwives • Clinical nurse specialists (CNSs) • Certified registered nurse anesthetists • Clinical psychologists (CPs) and clinical social workers (CSWs)5 • Registered dietitians or nutrition professionals

Place of Service:

For synchronous telehealth services in Medicare, a POS 02 must go on the bill. The POS used when the services are not synchronous is where the service took place at the time of the encounter.

Modifiers:

• G0 (zero): Used to identify telehealth services furnished for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke.

• GQ: (not used outside of Alaska or Hawaii): asynchronous telehealth service.

• GT: Critical Access Hospital distant site providers billing under CAH Optional Method II. This goes on an institutional claim and pays 80% of the Professional Fee Service rate.

• GY: Notice of Liability Not Issued, Not Required Under Payer Policy. Used to report that an Advanced Beneficiary Notice (ABN) was not issued because item or service is statutorily excluded or does not meet definition of any Medicare benefit.

• 95: Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System.

REMOTE EVALUATION AND VIRTUAL CHECK-IN

• G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store-and-forward). (Not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available) (appx reimbursement: $12)

• G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient. (not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available) appointment; 5-10 minutes of medical discussion. (appx reimbursement: $15)

(The patient must verbally consent to receive virtual check-in services. The Medicare coinsurance and deductible would apply to these services.)

REMOTE PHYSIOLOGIC MONITORING

• 99457: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month. (appx reimbursement: $52)

• 99453: Device initial set-up code which can be billed after 16 days of monitoring. (appx reimbursement: $20)

• 99454: The transmission code that should be billed at the end of each 30-day monitoring period or after monitoring has ended (if less than 30 days) based on CMS guidance on other remote monitoring services. (appx reimbursement: $64)

eCONSULT OR INTERPROFESSIONAL CONSULTATIONS

FQHCs and RHCs cannot bill for eConsult under Medicare.

• 99446-99449: Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional (5 minutes through and over 31 minutes). (appx reimbursement: $19, $38, $55, $74)

• 99451: Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time. (appx reimbursement: $36)

• 99452: Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/ requesting physician or other qualified health care professional, 30 minutes. (appx reimbursement: $38)

ONLINE DIGITAL EVALUATION SERVICE (eVISIT)

A communication between a patient and their provider through an online patient portal.

CPTs for qualified healthcare professionals who can bill E&M services.

• 99421: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 5-10 minutes. (appx reimbursement: $15)

• 99422: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11-20 minutes. (appx reimbursement: $32)

• 99423: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 21 or more minutes. (appx reimbursement: $53)

CPTs for qualified nonphysician healthcare professionals (clinical staff can be pharmacists, medical assistants, technicians, nurses, therapists) who cannot independently bill E&M services.

• 98970 (G2061 for Medicare): Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes. (appx reimbursement: $12)

• 98971 (G2062 for Medicare): Qualified nonphysician healthcare professional online assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes. (appx reimbursement: $23)

• 98972 (G2063 for Medicare): Qualified nonphysician qualified healthcare professional assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes. (appx reimbursement: $33)

MEDICARE TELEHEALTH VISITS

A visit with a provider that uses telecommunication system between a provider and a patient.

Common telehealth codes include:

• 99201-99205: New outpatient evaluation and management.

• 99211-99215: Established outpatient evaluation and management.

• G0425-G0427: Telehealth consultations, emergency department or initial inpatient.

• G0406-G0408: Follow-up inpatient telehealth consultation furnished to the beneficiaries in hospitals or SNFs.

(complete list available at: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes)

KEEP IN MIND

Medicare will pay for the telehealth services based on HRSA guidelines and it can be reviewed at https://data.hrsa.gov/tools/medicare/telehealth

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA):  Effective immediately (March 17^th, 2020), 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.  For more information:

https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

Resources:

https://www.cms.gov

https://www.aha.org

https://www.dhcs.ca.gov

https://med.noridianmedicare.com

https://www.federalregister.gov

https://searchhealthit.techtarget.com

https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-16041.pdf

https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-24086.pdf

https://www.ama-assn.org

https://www.ihs.gov

https://innovation.cms.gov

https://www.cchpca.org

#telemedicine #telehealth #digitalhealth #medicare #CMS #hippa

COVID-19: FFS Response and Nursing Home Visitor Guidance #coronavirus #covid19

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) Special Edition – Monday, March 16, 2020 Medicare FFS Response to COVID-19 COVID-19 Nursing Home Visitor Guidance Medicare FFS Response to COVID-19 The HHS Secretary declared a public health emergency, which allows for CMS programmatic waivers based on Section 1135 of the Social Security Act. An MLN Matters Special Edition Article SE20011 on Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus is available. Learn about blanket waivers issued by CMS. These waivers prevent gaps in access to care for beneficiaries impacted by the emergency. See the press release outlining our announcement. COVID-19 Nursing Home Visitor Guidance On March 13, as part of the broader Trump Administration announcement, CMS announced critical new measures designed to keep America’s nursing home residents safe from the 2019 Novel Coronavirus (COVID-19). The measures take the form of a memorandum and is based on the newest recommendations from the Centers for Disease Control and Prevention (CDC). It directs nursing homes to significantly restrict visitors and nonessential personnel, as well as restrict communal activities inside nursing homes. The new measures are CMS’s latest action to protect America’s seniors, who are at highest risk for complications from COVID-19. While visitor restrictions may be difficult for residents and families, it is an important temporary measure for their protection. For More Information: Press Release Memo Nursing Home Guidance QSO-20-14 –NH This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit  the coronavirus.gov webpage. For information specific to CMS, visit the Current Emergencies website. Like our newsletter? Have suggestions? Please let us know! The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registeredtrademarks of the U.S. Department of Health and Human Services (HHS).

#coronavirus
#covid19
#CMS
#medicareupdates

COVID-19: Test Pricing, Diagnostic Lab Tests, Pricing & Codes, and EHB Coverage #coronavirus #covid19

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) Special Edition – Friday, March 13, 2020 COVID-19: Test Pricing, Diagnostic Lab Tests, Pricing & Codes, and EHB Coverage COVID-19: Test Pricing; Diagnostic Lab Tests, Pricing & Codes; and EHB Coverage Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment MLN Matters® Article Essential Health Benefits (EHB) Coverage COVID-19: Test Pricing; Diagnostic Lab Tests, Pricing & Codes; and EHB Coverage On March 12, CMS posted a fact sheet with information relating to the pricing of both the Centers for Disease Control and Prevention (CDC) and non-CDC tests. Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment MLN Matters® Article A new MLN Matters Article MM 11681 on Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment is available. Learn about Advanced Diagnostic Laboratory Tests, pricing, and new codes. On page 3, we reference new COVID-19 codes. Essential Health Benefits (EHB) Coverage On March 12, CMS issued Frequently Asked Questions (FAQs) about EHB to ensure individuals, issuers, and states have clear information on coverage benefits for COVID-19. This action is part of the broader, ongoing effort by the White House Coronavirus Task Force to ensure that all Americans – particularly those at high-risk of complications from the COVID-19 virus – have access to the health benefits that can help keep them healthy while helping to contain the spread of this disease. These FAQs, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19; visit the CDC's Coronavirus Disease 2019 webpage. For information specific to CMS, please visit the Current Emergencies website. Like our newsletter? Have suggestions? Please let us know! The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registeredtrademarks of the U.S. Department of Health and Human Services (HHS).

CMS Develops Additional Code for Coronavirus Lab Tests - Agency Issues Fact Sheets Detailing Coverage under Programs

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) Special Edition – Friday, March 6, 2020 CMS Develops Additional Code for Coronavirus Lab Tests Agency Issues Fact Sheets Detailing Coverage under Programs  On March 6, CMS took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19).  CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well.  “CMS continues to leverage every tool at our disposal in responding to COVID-19,” said CMS Administrator Seema Verma. “Our new code will help encourage doctors and laboratories to use these essential tests for patients who need them. At the same time, we are providing critical information to our 130 million beneficiaries, many of whom are understandably wondering what will be covered when it comes to this virus. CMS will continue to devote every available resource to this effort, as we cooperate with other government agencies to keep the American people safe.” HCPCS is a standardized coding system that Medicare and other health insurers use to submit claims for services provided to patients. Last month, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers. CMS expects that having specific codes for these tests will encourage testing and improve tracking.  The Medicare claims processing systems will be able to accept these codes starting on April 1, 2020, for dates of service on or after February 4, 2020. Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates. Laboratories may seek guidance from their MAC on payment for these tests prior to billing for them. As with other laboratory tests, there is generally no beneficiary cost sharing under Original Medicare. To ensure the public has clear information on coverage and benefits under CMS programs, the agency also released three fact sheets that cover diagnostic laboratory tests, immunizations and vaccines, telemedicine, drugs, and cost-sharing policies.  Medicare Fact Sheet Highlights:  In addition to the diagnostic tests described above, Medicare covers all medically necessary hospitalizations, as well as brief “virtual check-ins,” which allows patients and their doctors to connect by phone or video chat. Medicaid and Children’s Health Insurance Program (CHIP) Fact Sheet Highlights:  Testing and diagnostic services are commonly covered services, and laboratory and x-ray services are a mandatory benefit covered and reimbursed in all states. States are required to provide both inpatient and outpatient hospital services to beneficiaries. All states provide coverage of hospital care for children and pregnant women enrolled in CHIP. Specific questions on covered benefits should be directed to the respective state Medicaid and CHIP agency. Individual and Small Group Market Insurance Coverage: Existing federal rules governing health insurance coverage, including with respect to viral infections, apply to the diagnosis and treatment of with Coronavirus (COVID-19). This includes plans purchased through HealthCare.gov. Patients should contact their insurer to determine specific benefits and coverage policies. Benefit and coverage details may vary by state and by plan. States may choose to work with plans and issuers to determine the coverage and cost-sharing parameters for COVID-19 related diagnoses, treatments, equipment, telehealth and home health services, and other related costs. Summary of CMS Public Health Action on COVID-19 to date: On March 4, 2020, CMS issued a call to action to healthcare providers nationwide to ensure they are implementing longstanding infection control procedures and issued important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare facilities to focus exclusively on issues related to infection control and other serious health and safety threats. For more information on CMS actions to prepare for and respond to COVID-19, visit: CMS Announces Actions to Address Spread of Coronavirus. On February 13, 2020, CMS issued a new HCPCS code for healthcare providers and laboratories to test patients for COVID-19 using the CDC-developed test. For more information about this code: Public Health News Alert: CMS Develops New Code for Coronavirus Lab Test. On February 6, 2020, CMS issued a memo to help the nation’s healthcare facilities take critical steps to prepare for COVID19. On February 6, 2020, CMS also gave CLIA-certified laboratories information about how they can test for SARS-CoV-2. Read more: Suspension of Survey Activities memorandum For the updated information on the range of CMS activities to address COVID-19, visit the Current Emergencies webpage. Like our newsletter? Have suggestions? Please let us know! The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health and Human Services (HHS).

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Ambulance Fee Schedule, Transports & Data Collection

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) Thursday, March 5, 2020 News DMEPOS Suppliers: HCPCS Codes Affected by Further Consolidated Appropriations Act Medicare Promoting Interoperability Program: CAH Reconsideration Forms due March 6 Medicare Promoting Interoperability Program: Submit Proposals for New Measures by July 1 PEPPERs for Short-term Acute Care Hospitals 2018 Geographic Variation Public Use File Help Your Patients Make Informed Food Choices Compliance Ambulance Fee Schedule and Medicare Transports Claims, Pricers & Codes Average Sales Price Files: April 2020 Events Ground Ambulance Organizations: Data Collection for Public Safety-Based Organizations Call — March 12 Open Payments: Your Role in Health Care Transparency Call — March 19 Anesthesia Modifiers: Comparative Billing Report Webinar — March 19 Ground Ambulance Organizations: Data Collection for Medicare Providers Call — April 2 LTCH and IRF Quality Reporting Programs: SPADEs In-Depth Training Event — June 9-10 MLN Matters® Articles Standard Elements for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Orders Prior to Delivery and, or Prior Authorization Requirements Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update Quarterly Update for the Temporary Gap Period of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - April 2020 International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) -- July 2020 Update Publications Administrative Simplification: Claim Status Basics Hospice Quality Reporting Program: Timeliness Compliance Threshold for HIS Submissions Guide to Reducing Chronic Kidney Disease Disparities in the Primary Care Setting Multimedia Ambulance Services Call: Audio Recording and Transcript View the full edition as a: PDF | Webpage Like our newsletter? Have suggestions? Please let us know! The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health and Human Services (HHS).

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