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New Telemedicine CPT Codes Created

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After a long wait, the Current Procedural Terminology (CPT) codes have finally been updated to include telemedicine. A “95” modifier can be added to CPT codes for real-time remote encounters with a video and audio component; the list includes outpatient evaluation and management (E/M) codes, consultation codes, and behavioral health codes, among others. Additionally, a new place of service (POS) code, telemedicine CPT code 02, is required for clinicians who bill for telemedicine services. Read more

MACRA consists of the APM and MIPS programs

Medicare Reimbursements Shift towards Quality of Care

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In an open letter last Friday, October 14, the Centers for Medicare and Medicaid Services (CMS), announced the finalized policies for implementing the new Medicare Quality Payment Program (QPP). Although the rule takes effect on January 1, 2017, several components will be phased in over the next few years to give physicians time to adjust accordingly. Many of the policies have been updated from the previous proposal in response to feedback from clinicians across the country. Read more

Doctor holding sign that says, "Medicare"

Telemedicine Use Rising Rapidly among Medicare Beneficiaries

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In one of the first published studies to measure exactly how often telemedicine is utilized, Harvard Medical School researchers discovered that telemedicine use among Medicare patients grew roughly 28 percent each year between 2004 and 2013. This rise is even more impressive in light of Medicare’s restrictive reimbursement policy: Medicare only pays for telemedicine visits if the patient lives in a rural area and travels to a clinic for the telemedicine visit. Read more

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ATA and AMA Team Up to Increase Reimbursement for Telehealth

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In a move aimed at increasing reimbursement for telehealth services, the American Telemedicine Association (ATA) and American Medical Association (AMA) are working together to suggest new CPT codes to the Centers for Medicare & Medicaid Services (CMS) later this month. If accepted, the new codes would allow CMS to recognize and reimburse more telemedicine services. Read more

reimbursement for telemedicine

Medicare Falls Behind in Reimbursement for Telemedicine

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You might think that the passage of the Affordable Care Act in 2010 and the resulting opportunities for telemedicine would have led to widespread telemedicine usage to increase access to healthcare while reducing costs, but the reality is that reimbursement from government agencies—such as Medicare—has fallen far behind the rhetoric. And when good intentions aren’t backed up with adequate funding, progress can become slower than molasses.

Telemedicine has certainly grown steadily, but the impact has been felt more significantly among those with private insurance that provides reimbursement for telemedicine visits. Among Medicare beneficiaries, less than 1% have coverage for telemedicine (1). And of those who are fortunate enough to enjoy such coverage, particularly those in rural areas, Medicare often requires the beneficiary to already be at a clinic. So much for making healthcare more convenient. Read more

New York Telehealth

New York joins the Telemedicine Party…er, Parity

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New York Telehealth

Making a momentous step forward, last week New York Governor Andrew Cuomo signed into law a bill requiring private insurers to cover telehealth and telemedicine coverage, retroactive to January 1st, 2015 (Happy New Year!).

That was not a redundant sentence: New York has differentiated between telehealth and telemedicine in the bill, with the primary difference being that telemedicine must include Read more

Maybe You Can get Reimbursed for That…

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Treasure In Paper

Last week I posted a press release from the ATA about expanded Medicare coverage for Telemedicine.  Well, I decided to actually read the 1200 page rulemaking from the Centers for Medicare and Medicaid Services (CMS).  You can guess why it’s taken a week to write a follow up article…

Actually, no.  I didn’t read the entire rulemaking, only the pages relevant to all things “tele” in medicine and healthcare.  In doing so, I was reminded of something interesting:

There are a number of procedures already covered by Medicare without specific telemedicine codes.  In fact, of the seven bullet points listing the 22 codes rejected or deleted from inclusion, five noted the affected codes were largely unnecessary due to either an existing telehealth code or because Medicare does not distinguish whether the procedure is tele or not.

Here are a few examples:

Regarding electrocardiograms and echocardiograms: “By definition, Read more

ATA Celebrates Halloween Telemedicine Treats for Medicare Beneficiaries

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WASHINGTON – Saturday, Nov. 1, 2014 — Yesterday, the Centers for Medicare and Medicaid Services (CMS) issued a rulemaking that includes significant additional coverage for telemedicine services.

“This Halloween, Medicare beneficiaries got an important treat for home care of chronic care management, remote patient monitoring of chronic conditions, and other services when provided via telehealth,” said Jonathan Linkous, CEO of the American Telemedicine Association. The association has been asking CMS for such coverage for over five years.

Buried in an almost 1200-page rulemaking about 2015 Medicare payments to physicians and practitioners were provisions paying for remote chronic care management using a new current procedural terminology (CPT) code, 99490, with a monthly unadjusted, non-facility fee of $42.60. Also, Medicare will pay for remote-patient monitoring of chronic conditions with a monthly unadjusted, non-facility fee of $56.92 using CPT code 99091. Prior to this, Medicare did not pay separately for such services, requiring that such billing be bundled with an “evaluation and management” code.

Also in the rulemaking were seven new covered procedure codes for telehealth including annual wellness visits, psychotherapy services, and prolonged services in the office.

“It has been a long time coming, but this rulemaking signals a clear and bold step in the right direction for Medicare,” added Linkous. “This allows providers to use telemedicine technology to improve the cost and quality of healthcare delivery.”

Read the full document here: http://www.regulations.gov/#!documentDetail;D=CMS-2014-0094-2363. To learn more about telemedicine and public policy, visit http://www.americantelemed.org/policy/overview-news.

About the American Telemedicine Association

The American Telemedicine Association is the leading international resource and advocate promoting the use of advanced remote medical technologies. ATA and its diverse membership work to fully integrate telemedicine into healthcare systems to improve quality, equity and affordability of healthcare throughout the world. Established in 1993, ATA is headquartered in Washington, DC. For more information visit www.americantelemed.org.

Media Contact:
Mimi Hubbard
mhubbard@americantelemed.org
202-659-7616

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