2021 EXPANSION OF TELEHEALTH SERVICE COVERAGE BY CMS

On August 3, 2020, the Center for Medicare and Medicaid published its Proposed Rules for Medicare Physician Fee Schedule (PFS) for Calendar Year 2021.  Public Comment period on the Proposed Rule ended on October 5, 2020.  In the Proposed Rule, CMS proposed to add several telehealth services to its coverage on a permanent basis for 2021.  CMS further proposed to introduce additional coverage for telehealth services on an interim basis.  The Final Rule is expected to publish in November 2020.   The provisions of the Final Rule will become effective as of January 1, 2021.

In this Proposed Rule CMS proposed to boost telehealth services in light of the federally declared public health emergency, COVID-19 pandemic, and President Trump’s Executive Order on Improving Rural Health and Telehealth Access.  The Executive Order directed the Department of Health and Human Services (HHS) Secretary to propose a regulation expanding the number of telehealth services offered to Medicare beneficiaries during and after the public health emergency.

Each year CMS adds permanent telehealth services on the basis of Category 1 or Category 2.  Category 1 is for services that are similar to professional consultations, office visits, and office psychiatric services that are currently on the Medicare telehealth services list.  Category 2 is for services that are not similar to those currently on the telehealth list.

The CMS has proposed to add nine (9) additional telehealth services on a Category 1 basis, as follows: 

·         Visit complexity inherent to evaluation and management associated with primary medical services that serve as the focal point for all needed health care services - HCPCS Code GPC1X;

·         Group psychotherapy - HCPCS Code 90853;

·         Neurobehavioral Status Exam - HCPCS Code 96121;

·         Prolonged Services - HCPCS Code 99XXX;

·         Assessment and care planning for patients with cognitive impairment - HCPCS Code 99483;

·         Domiciliary or rest home services for established patients - HCPCS Code(s) 99336 and 99337; and,

·         Home visits for the evaluation and management of an established patient - HCPCS Code(s) 99347 and 99348

CMS has also proposed to create a new Category 3 for telehealth services. Category 3 would encompass certain services that were added, on an interim basis, as telehealth services during the public health emergency under the March 31 COVID-19 Interim Final Rule with Comment Period (IFC) and the May 1 COVID-19 IFC.  Category 3 services lack sufficient evidence to list as permanent additions under Category 1 or 2.  Category 3 telehealth services will remain on the Medicare telehealth services list until the end of the calendar year in which the public health emergency ends.

The Proposed Rule adds 13 telehealth services on a Category 3 basis, as follows:

• Domiciliary, rest home, or custodial care services for the evaluation and management of an established patient - HCPCS Code(s) 99336 and 99337;

• Home visits for established patients - HCPCS Code(s) 99349 and 99350;

• Emergency Department visits for evaluation and management of a patient - HCPCS Code(s) 99349 and 99350;

• Nursing facilities discharge day management – HCPCS Code(s) 99315 and 99316; and,

• Psychological and Neuropsychological testing evaluation services by a physician or other qualified health care professional – HCPCS Code(s) 96130-96133

CMS was also seeking comments on addition of other telehealth services as Category 3 on an interim basis as follows:

• Initial and final discharge interactions – CPT Code(s) 99234-99236 and 99238-99239;

• Higher level Emergency Department visits – CPT Code(s) 99284 and 99285;

• Hospital, Intensive Care Unit, Emergency care, and Observation stays – CPT Code(s) 99217-99220, 99221-99226, 99484, 99468-99472, 99475-99476, and 99477-99480)

The Proposed Rule further clarified requirements for the virtual “direct supervision” that was adopted by CMS in the Final Policy dated April 6, 2020 (85 FR 19230).  In the Final Policy of April 2020, CMS had relaxed the “direct supervision” rules during the federally declared public health emergency to allow virtual presence of the supervising physician or practitioner via interactive audio/video real-time communications.  CMS generally requires “direct supervision” of auxiliary personnel to bill “incident to” a physician or non-physician practitioner.  The Proposed Rule clarified that “direct supervision” does not require real-time presence or observation of the procedure, but only requires that the supervising physician/practitioner be immediately available to engage via audio/video technology. The Final Policy on virtual “direct supervision,” aimed to reduce close contact between healthcare providers, will expire on December 31, 2020 or with the public health emergency, whichever is later.