CMS Provides Medicare Reimbursement for More Telehealth During PHE

Medicare Reimbursement or Telehealth

CMS recently added 11 new services to the Medicare telehealth services list, qualifying the services for Medicare reimbursement through the COVID-19 public health emergency (PHE). The new telehealth services cover some cardiac and pulmonary rehabilitation services, as well as certain neurostimulator analysis and programming services.

The additions to the Medicare telehealth list were made in response to President Trump’s Executive Order on Improving Rural health and Telehealth Access and marked the first time CMS has used a new expedited process for expanding the list, according to an announcement made yesterday.

“Responding to President Trump’s Executive Order, CMS is taking action to increase telehealth adoption across the country,” said CMS Administrator Seema Verma. “This revolutionary method of improving access to care is transforming healthcare delivery in America. President Trump will not let the genie go back into the bottle.”

The Medicare telehealth list identifies the telehealth services Medicare will pay for through the duration of the COVID-19 PHE. Since the PHE started, CMS has added over 135 services to the list for a wide range of provider services, including emergency department visits, initial inpatient and nursing facility visits, and discharge day management services.

The most recent telehealth codes to be added and their short descriptions are:

  • 93797: Cardiac rehab
  • 93798: Cardiac rehab/monitor
  • 93750: Interrogation vad in person
  • 95970: Alys npgt w/o prgrmg
  • 95971: Alys smpl sp/pn npgt w/prgrm
  • 95972: Alys cplx sp/pn npgt w/prgrm
  • 95983: Alys brn npgt prgrmg 15 min
  • 95984: Alys brn npgt prgrmg addl 15
  • G0422: Intens cardiac rehab w/exerc
  • G0423: Intens cardiac rehab no exer
  • G0424: Pulmonary rehab w exer

With the new additions, Medicare will now pay for 144 services performed via telehealth under the Medicare Physician Fee Schedule.

The use of telehealth in Medicare increased significantly at the start of the COVID-19 PHE, with over 12.1 million traditional Medicare beneficiaries receiving a telehealth service between mid-March and mid-August 2020. That represents over 36 percent of beneficiaries, CMS reported in the announcement.

Additionally, telehealth use increased among Medicaid and CHIP beneficiaries, according to a preliminary data snapshot also revealed in the announcement.

The preliminary Medicaid and CHIP data snapshot on telehealth utilization during the PHE showed that telehealth utilization among beneficiaries in the two programs increased by over 2,600 percent between March and June 2020. In total, there were more than 34.5 million Medicaid and CHIP services delivered via telehealth during the period.

The snapshot also found that adults between the ages of 19 and 64 years received the most telehealth services during the start of the PHE.

CMS hopes to drive telehealth in Medicaid and CHIP. The agency recently released a new supplement to its state Medicaid & CHIP telehealth toolkit, which contains policy considerations for states expanding the use of telehealth during COVID-19. The supplement provides new examples and lessons learned from states that have already implemented telehealth changes.

“The updated supplemental information is intended to help states strategically think through how they explain and clarify to providers and other stakeholders which policies are temporary or permanent,” CMS stated in the announcement. “It also helps states identify services that can be accessed through telehealth, which providers may deliver those services, the ways providers may use in order to deliver services through telehealth, as well as the circumstances under which telehealth can be reimbursed once the PHE expires.”

For More Information: