CMS Interim-Final COVID-19 Rule: Deep Dive Into Telehealth and Communication Technology-Based Services

After receiving feedback from the ACC and other leading medical associations and groups, the Centers for Medicare and Medicaid Services (CMS) issued an interim-final rule this week formalizing many temporary waivers and flexibilities to streamline response to the COVID-19 pandemic. The rule also expands the list of eligible Medicare telehealth services and alters MIPS requirements and extensions. Learn about the blanket waivers and burden relief here, and coverage and quality policy updates here.

As part of the interim-final rule, CMS incorporated additions to facilitate the use of telecommunications technology as a safe substitute for in-person services – eliminating frequency limitations and other requirements associated with particular services furnished via telehealth, and clarifying several payment rules that apply to other services that are furnished using telecommunications technologies that can reduce exposure risks. Some changes below apply to communication technology-based services that are considered part of the Medicare Telehealth Program, some to technology services that are remote and may commonly be referred to as "telehealth," and some to both categories of services. All "Medicare Telehealth Program" services are telehealth/telemedicine/remote/technology-based. Not all telehealth/telemedicine/remote/technology-based services are included in the "Medicare Telehealth Program."

Medicare Telehealth Program

  • An "interactive telecommunications system"may be a smart phone, but it still requires audio and video components.
  • Medicare Telehealth services can be furnished to patients wherever they are located, including in the patient's home. For example, a physician practicing in an office setting who, under the public health emergency (PHE) for the COVID-19 pandemic, sees patients via telehealth instead of in person, would be paid at the non-facility, or office, rate for these services.
  • To capture the technical component aspects, report the POS code that would have been reported had the service been furnished in person.
  • Use the CPT telehealth modifier (modifier 95), which should be applied to claim lines that describe services furnished via Telehealth.
  • Many services were added to the list of allowed Telehealth services, including initial patient inpatient visits, home visits, initial nursing facility visits and others in the complete list.
  • Frequency limitations on subsequent inpatient visits, nursing facility visits, and critical care consultations are eliminated.
  • CMS is revising policy to specify that the office/outpatient E/M level selection for these services when furnished via telehealth can be based on medical decision making (MDM) or time, with time defined as all of the time associated with the E/M on the day of the encounter. Practitioners must document E/M visits as necessary to ensure quality and continuity of care. Requirements regarding documentation of history and/or physical exam in the medical record are waived. The current definition of MDM will apply.
  • The Office of Civil Rights is exercising enforcement discretion and waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the PHE for the COVID-19 pandemic.

Communication Technology-Based Services

  • Telephone assessment/management codes 99441-99443 and 98966-98968 will now be paid using RVU recommendations from 2008 development. This provides new audio-only flexibility beyond G2012.
  • HCPCS Codes G2010 and G2012 can now be provided to new as well as established basis for the interim and consent can be documented by auxiliary staff under general supervision. Consent to receive these services can be obtained annually but it may be obtained at the same time that a service is furnished.
  • Physicians can provide direct supervision virtually through audio/video real-time communications technology when use of such technology is indicated to reduce exposure risks for the beneficiary or health care provider.
  • Remote Physiologic Monitoring services (99091, 99453, 99458, 99473, 99474) can now also be furnished to new patients and can be used for either chronic or acute conditions.

These temporary program changes and waivers are explained in greater specificity in either the interim-final rule, supplementary fact sheets, or both. See "Related Content" to learn more. ACC staff continue to work with the House of Medicine to monitor regulatory updates and provide feedback to CMS.

Clinical Topics: COVID-19 Hub

Keywords: Coronavirus, ACC Advocacy, Medicare, Centers for Medicare and Medicaid Services, U.S., Telemedicine, COVID-19, Medicaid

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