The Centers for Medicare and Medicaid Services (CMS) defines telehealth services as office visits, psychotherapy, consultations, and certain other medical or health services that are provided by an eligible provider who isn't at your location using an interactive two-way telecommunications system (like real-time audio and video). The original intent was to provide services to rural areas with significant restrictions (e.g., the provider was required to provide such services from specific locations as designated by CMS).
As of March 6, 2020, CMS has instituted a temporary emergency broadening of access to Medicare telehealth services in response to the coronavirus disease (COVID-19) crisis.
Under both legislative and Section 1135 waiver authority granted to CMS, Medicare providers now may use telehealth technology when providing various services to patients including evaluation and management (E/M) services that previously required face-to-face visits.
Some important additional changes include:
Important Coding and Reimbursement Tips:
Medical record documentation should include:
Telehealth services can be provided via telephonic communication and/or via a video encounter. They should be billed with Place of Service (POS) equal to what it would have been had the service been furnished in-person. Modifier 95, Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System, should also be applied indicating that the service was provided via telehealth. These codes will be reimbursed at the facility rate.
Many commercial payers have also temporarily modified their payment rules relating to telehealth visits. It is recommended that you contact your local payers directly in order to discuss their most current payment rules.Back To Top
CMS broadens telehealth terms for COVID-19 crisis. Appl Rad Oncol.