Summary of New Medicare Telehealth Flexibilities

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By Capitol Associates, Inc. 

On April 30th, the Centers for Medicare and Medicaid Services (CMS) announced a number of new blanket waivers and regulatory flexibilities.

Announcement: https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid

The announcement includes new Medicare telehealth coverage flexibilities. Below is a summary of these new telehealth policies. Please refer to the Interim Final Rule (IFR) for a more detailed explanation of these provisions.

IFR: https://www.cms.gov/files/document/covid-medicare-and-medicaid-ifc2.pdf

All of the telehealth policies in the rule are retroactive to March 1, 2020. These policies will last through the duration of the COVID-19 public health emergency.

Audio-only Telehealth

CMS is adding more services to its list of telehealth services that can be provided by an audio-only telephone connection instead of a real time audio-visual connection. CMS is also increasing the payment rates for these services. Medicare Telehealth services require a real time audio and visual connection unless CMS specifies that a telehealth code can be provided by audio-only connection.

The list of telehealth codes that can be provided with an audio-only telephone connection can be downloaded from this website https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

Additionally, CMS is waiving the video requirement for certain telephone evaluation and management services (99441-99443), and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to receive these services. CMS is also updating the payment rates for these services to equal the payment rates for 99212-99214, respectively.

Expansion of Clinician-types That Can Provide Telehealth

For the duration of the COVID-19 emergency, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.

Site and Site Neutral Payments for Telehealth Services Provided to a Patient at Home

When telehealth services are delivered to a patient who is registered as an outpatient of a hospital during service delivery is located in their home, CMS technically considers the patient’s home to be an off-campus hospital outpatient department (OPD). CMS is clarifying that it will not impose its site-neutral payment policy that reduces payments for new off-campus OPDs for telehealth services provided to patients at home. However, CMS notes that the hospital must seek an exception under the temporary extraordinary circumstances relocation exception policy to avoid the site neutral payment reduction.

Using Time to Determine the Appropriate Telehealth Evaluation and Management Code

CMS previously said that providers can use Medical Decision Making (MDM) or time, with time defined as all of the time associated with the Evaluation and Management (E/M) service on the day of the encounter, to determine the appropriate code for telehealth E/M services. CMS is revising how it defines time for this purpose. CMS acknowledges that the time associated with the E/M service on the day of the encounter does not always align with the time values in the various E/M codes. CMS will now require providers to use the times listed in the codes themselves if time is used to determine the appropriate E/M code.

Updating the Medicare Telehealth Codes

CMS will update its list of approved Medicare telehealth codes using a sub-regulatory process that is more efficient than the formal regulatory process that is currently used. This means CMS could make more frequent updates to its approved telehealth code list going forward.

Hospital OPDs as Telehealth Originating

Hospitals may bill as the originating site for telehealth services furnished by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is located at home.


Please  contact the AHRA Regulatory Affairs Committee with any regulatory questions you may have at regulatory@ahra.org.


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