Medicare provides more regulatory relief in response to COVID-19

Last week, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule that made many significant Medicare payment policy changes effective March 1, 2020, and for the duration of the COVID-19 public health emergency. The rule included several highlights for family physicians.

CMS added Medicare coverage of and payment for telephone evaluation and management (E/M) services (CPT codes 99441-99443). Although the code descriptors only reference “established patients,” CMS will cover and pay for both new and established patients during the emergency. In fact, CMS now allows almost all telehealth, virtual check-ins, and e-visits to be provided to any patient – new or established.

CMS will allow physicians to select the level of office/outpatient E/M visit (CPT codes 99201-99215) furnished via Medicare telehealth based on medical decision making (MDM) or time. CMS has removed any requirements regarding documentation of history and/or physical exam in the medical record for such visits. For this purpose, “time” is defined as all the time associated with the E/M on the day of the encounter. The current typical times associated with office/outpatient E/M codes in CPT are what should be met for the purposes of level selection. CMS is maintaining the current definition of MDM.

CMS also expanded the list of services that can be provided via telehealth and will provide payment for telehealth services at the non-facility rate under the Medicare physician fee schedule when appropriate. CMS encourages physicians to bill the telehealth service with the Place of Service (POS) code they would have used if the service had been provided in-person and append CPT modifier 95 (“Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System”) to the claim lines that describe services delivered via telehealth. Any service reported with POS 02 (“Telehealth”) will be paid at the facility rate under the Medicare physician fee schedule, which tends to be less than the corresponding non-facility rate.

CMS has also stated that physicians will not be subject to sanctions for routinely reducing or waiving cost sharing for a broad category of non-face-to-face services, including:

• Telehealth visits
• Virtual check-in services
• E-visits
• Monthly remote care management
• Monthly remote patient monitoring

Finally, for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), CMS expanded the services included in Virtual Communication Services (code G0071) to include the services reflected in CPT codes 99421-99423 (Online digital E/M services). Accordingly, CMS will revise the payment amount of G0071 to the average national non-facility amount for codes G2012, G2010, and 99421-99423. All virtual communication services billable using code G0071 will also be available to new patients that have not been seen in the RHC or FQHC within the previous 12 months.

For more information, you can check out the fact sheet and the COVID-19 flexibilities webpage on the CMS website.  

— Kent Moore, Senior Strategist for Physician Payment