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CMS Adds to List of Reimbursable Telehealth Services

November 30, 2015:

Several services were added to the list of Medicare covered telehealth services in a physician fee schedule final rule published in the Federal Register November 16. The rule contains provisions for calendar year 2016.

The following CPT® codes have been added to the list of covered telehealth services in category I (services that are similar to professional consultations, office visits, and office psychiatry services currently on the list of covered telehealth services):

Codes 99356 and 99357 for the first hour and each additional 30 minutes of prolonged services in the inpatient or observation setting: Only subsequent hospital and nursing facility visit codes are on the list of covered telehealth services. Codes 99356 and 99357, therefore, are reportable only with codes with limits of one subsequent hospital visit every three days via telehealth and one subsequent nursing facility visit every 30 days.

Codes 90963, 90964, 90965, and 90966 for end-stage renal disease-related services for home dialysis for a full month for patients younger than 2 to 20-years-old and older: The Centers for Medicare and Medicaid Services notes that the clinical examination of the catheter access site must be performed in person without the use of telehealth by a physician, certified nurse specialist, nurse practitioner, or physician’s assistant. However, additional visits may be provided via telehealth under the two-to-three-visit monthly capitation payment code and the four-or-more-visit MCP code.

To be payable by Medicare, telehealth services must, in addition to being on the list of covered services, be furnished through an interactive telecommunications system by a physician or other authorized practitioner to an eligible individual receiving the service at a telehealth originating site. Such a site must be in a medical facility (not the patient’s home) in a health professional shortage area (HPSA) or in a county not in a metropolitan statistical area (MSA).

Professionals providing telehealth services at the “distant site” are paid the same amount as they would be paid had they provided the services in person. The “originating site” at which the beneficiary receives the services is paid a facility fee.

CPT copyright © 2015 American Medical Association. All rights reserved.


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