During the start of the COVID19 pandemic, The Centers for Medicare and Medicaid Services (CMS) passed the 1135 waiver which allowed “broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility.” This waiver allowed those who were considered high risk to continue to receive treatment during a time when that ability may have been non-existent.
In an August 3rd press release, The CMS released new information that the Trump administration has proposed to expand telehealth benefits permanently for those who are Medicare beneficiaries past the pandemic timeline. But which services will be included in that expansion and what does this mean for those practices looking to add telehealth services?
Prior to the 1135 waiver, if a patient intended to see a medical professional they had to have an in-office visit. This type of limitation affected lower-income and rural patients at a disproportionate rate. In 2019, Medicare permitted payment for “virtual check-ins”, which allowed patients to have appointments over phone or video with health professionals to see if an in-person visit was needed.
After the COVID19 outbreak, the 1135 waiver was signed into order and it allowed Medicare to cover a variety of telehealth services to patients at the same rate as services offered by doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers in-person. This new proposal would allow Medicare to permanently add telehealth services to be covered services following the public health emergency (PHE), with some being covered until the end of the PHE, and others that will no longer be covered under Medicare in 2021.
What to Expect from Medicare Telehealth in 2021
For the Calendar Year 2021, CMS has proposed a variety of policy changes in regard to telehealth services. CMS has grouped the various telehealth services offered into three categories: Codes that will become permanent parts of Medicare, codes that will no longer be covered by Medicare upon the expiration of the PHE, and codes that will be available on a temporary basis after the expiration of the PHE.
Category 1 Services (Permanent)
The following services will fall under the Category 1 designation and will be made available permanently under medicare.
|Service Type||HCPCS Code|
|Visit Complexity Associated with Certain Office Outpatient E/Ms||GPC1X|
|Neurobehavioral Status Exam||96121|
|Care Planning for Patients with Cognitive Impairment||99483|
|Domiciliary, Rest or Home, or Custodial Care services||99334, 99335|
Category 2 Services (Discontinued)
The following services will fall under the Category 2 designation. CMS found no clinical benefit for these services after the PHE and will no longer be covered under medicare after the PHE.
|Service Type||HCPCS Code|
|Critical Care Services||99291,99292|
|Initial and Subsequent Observation and Observation Discharge Day Management||99217-99220, 99224-99226, 99234-99236|
|Initial Nursing facility visits, all levels||99304-99306|
|Psychological and Neuropsychological Testing||96136-96139|
|Therapy Services, Physical and Occupational Therapy, all levels||97161-97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507|
|Initial Hospital Care and Hospital Discharge Day Management||99221-99223, 99238-99239|
|Inpatient Neonatal and Pediatric Critical Care, Initial and Subsequent||99468-99472, 99475-99476|
|Initial and Continuing Neonatal Intensive Care Services||99477-99480|
|End-Stage Renal Disease Monthy Capitation Payment Codes||90952-90953, 90956, 90959, 90962|
|Radiation Treatment Management Services||77427|
|Emergency Department Visits, Levels 4-5||99284-99285|
|Domiciliary, Rest Home or Custodial Services||99324-99328|
|Home Visits, New Patient all levels||99341-99345|
Category 3 Services (Services Temporarily Continued During PHE)
The following services will fall under the Category 3 designation. CMS has created a new category for services that will be covered under Medicare temporarily for the remainder of the PHE.
|Service Type||HCPCS Codes|
|Domiciliary, Rest Home, or Custodial Care Services, Established Patients||99336, 99337|
|Home Visits, Established Patients||99349, 99350|
|Emergency Department Visits||99281-99283|
|Nursing Facilities Discharge Day Management||99315, 99316|
|Psychological and Neuropsychological Testing||96130-96133|
Telehealth services have become a staple of the American healthcare system. Since the beginning of 2020, patients and providers have grown accustomed to utilizing this technology to make everyone’s lives easier.
Beam Health believes in offering a platform for these appointments to happen that is easy to use and easy to implement into any provider system. If you are interested in learning more about the fastest growing telehealth platform available, please contact us here to set up an appointment with an implementation specialist!