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
Prolonged Services 99XXX
Group Psychotherapy 90853
Neurobehavioral Status Exam 96121
Care Planning for Patients with Cognitive Impairment 99483
Domiciliary, Rest or Home, or Custodial Care services 99334, 99335
Home Visits 99348

 

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!