December 28, 2020

During the course of this year, the Centers for Medicare and Medicaid Services (CMS) produced a number of rule changes concerning the utilization of telehealth services.  Generally, these services describe a remote patient encounter with a clinician by means of both (as opposed to either) audio and visual technologies.  Such encounters became all the more mainstream in 2020, given the concerns regarding physical interactions in this age of COVID.  Many of our readers—to include both anesthesiologists and interventional pain physicians—have asked about or actively utilized telehealth in connection with their practices.  Just as providers were getting used to the latest iteration of telehealth do’s and don’ts, the government is readjusting the goal posts once more.

The Medicare Physician Fee Schedule (PFS) Final Rule that was released early this month addresses new rules for those wishing to utilize telehealth in the coming year.  Based on a CMS press release summarizing the Final Rule, we wish to provide below a few key takeaways for telehealth in 2021.

Add That to The List

The government has added additional services to its “Category 1” list of telehealth services.  According to CMS, “Services added to the Medicare telehealth list on a Category 1 basis are similar to services already on the telehealth list.”  The new services added are as follows:

• Group Psychotherapy (CPT code 90853)
• Psychological and Neuropsychological Testing (CPT code 96121)
• Domiciliary, Rest Home, or Custodial Care services, Established Patients (CPT codes 99334-99335)
• Home Visits, Established Patient (CPT codes 99347-99348)
• Cognitive Assessment and Care Planning Services (CPT code 99483)
• Visit Complexity Inherent to Certain Office/Outpatient Evaluation and Management (E/M) (HCPCS code G2211)
• Prolonged Services (HCPCS code G2212)

The Final Rule also provides for the creation of “a third temporary category of criteria for adding services to the list of Medicare telehealth services,” to be known as “Category 3.”  This category describes services added to the Medicare telehealth list during the public health emergency (PHE) due to the coronavirus pandemic that will remain on the telehealth list through the calendar year in which the PHE ends.  So, then, if the PHE ends this coming spring, for example, the Category 3 list of services would continue to be included in the telehealth list of services through Dec 31, 2021.

The Final Rule also adds a number of services to the Medicare telehealth list on a Category 3 basis.  While nearly all of these new additions will not be used by our readers, one code set will be applicable to some of our anesthesia practices.  That code set involves critical care services, as reflected by codes 99291-99292.

Location, Location, Location

One of the questions that we periodically received over the last several months was also received by CMS.  They were asked whether a service could be reported as telehealth when both the billing provider and the patient were in the same physical location, such as when both are in the same healthcare facility.  The agency responded in its press release as follows:

We are, therefore, reiterating in this final rule that telehealth rules do not apply when the beneficiary and the practitioner are in the same location even if audio/video technology assists in furnishing a service.

Many of our clients have asked about doing pain rounds, for example, using audio/visual devices.  They are at the hospital where the patient is, but want to reduce the risk of spreading the virus by not entering the patient room.  In such a circumstance, the government’s position has been consistent.  You cannot bill under the telehealth provisions if you and the patient are in the same facility. 

Hearing but Not Seeing

Back in the spring, CMS issued an Interim Final Rule, establishing a separate payment for audio-only telephone (E/M) services.  The agency sought comment on whether they should develop coding and payment for a service similar to the virtual check-in but for a longer unit of time and consequently with a higher value.  They also sought input from the public on the duration of the services and the resources in both work and practice expense involved in furnishing this service.  Finally, CMS sought comment on whether this should be a provisional policy to remain in effect until a year after the end of the COVID-19 PHE, or be adopted as permanent PFS payment policy. 

Based on support from commenters, the CMS summary of the Final Rule states, “we are establishing payment on an interim final basis for a new HCPCS G-code describing 11-20 minutes of medical discussion to determine the necessity of an in-person visit.”

Other Telehealth Highlights

The American Medical Association (AMA) also published a summary of the Final Rule.  It’s treatment of the telehealth provisions include the following highlights:

• CMS did not permanently extend the Medicare telehealth geographic and site of service originating site restrictions, which temporarily allows Medicare beneficiaries across the country to receive care from their homes, citing a lack of statutory authority to do so. Therefore, the waivers in place will last only during the COVID-19 PHE.
   
• CMS kept over 150 additional services on the Medicare telehealth list until the end of the calendar year in which the PHE ends to allow more time to study the benefit of providing these services via telehealth.
   
• CMS finalized its proposal to allow direct supervision to be provided using real-time, interactive audio and video technology through the later of the end of the calendar year in which the PHE for COVID-19 ends or December 31, 2021.

As stated in our previous article, more details concerning the Final Rule will be forthcoming in future e-alerts over the next few weeks.  Feel free to reach out to us at info@anesthesiallc.com if you have questions.  Until then, we hope you are enjoying this holiday season and wish you and yours a Happy New Year!

With best wishes,

Tony Mira
President and CEO