During the coronavirus public health emergency, the Centers for Medicare and Medicaid (CMS) temporarily expanded telehealth reimbursement. However, as these temporary measures are set to expire once the public health emergency (PHE) has passed, there have been pleas for permanent expanded access. It was announced earlier this month that Congress has made CMS telehealth expansion permanent for beneficiaries in rural areas. More details are discussed below.
CMS Telehealth Expansion: What Services Have Been Added?
As stated above, the permanent CMS telehealth expansion only applies to beneficiaries in rural communities, and covers specific services.
The following are services covered by the CMS telehealth expansion.
Category 1 (reimbursable beyond the PHE):
- Group Psychotherapy (CPT code 90853)
- Psychological and Neuropsychological Testing (CPT code 96121)
- Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99334-99335)
- Home Visits, Established Patient (CPT codes 99347-99348)
- Cognitive Assessment and Care Planning Services (CPT code 99483)
- Visit Complexity Inherent to Certain Office/Outpatient Evaluation and Management (E/M) (HCPCS code G2211)
- Prolonged Services (HCPCS code G2212)
Category 3 (reimbursed through the calendar year in which the PHE ends):
- Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT 99336-99337)
- Home Visits, Established Patient (CPT 99349-99350)
- Emergency Department Visits, Levels 1-5 (CPT 99281-99285)
- Nursing facilities discharge day management (CPT 99315-99316)
- Psychological and Neuropsychological Testing ( CPT 96130- 96133; CPT 96136- 96139)
- Therapy Services, Physical and Occupational Therapy, All levels (CPT 97161- 97168; CPT 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507)
- Hospital discharge day management (CPT 99238- 99239)
- Inpatient Neonatal and Pediatric Critical Care, Subsequent (CPT 99469, 99472, 99476)
- Continuing Neonatal Intensive Care Services (CPT 99478- 99480)
- Critical Care Services (CPT 99291-99292)
- End-Stage Renal Disease Monthly Capitation Payment codes (CPT 90952, 90953, 90956, 90959, and 90962)
- Subsequent Observation and Observation Discharge Day Management (CPT 99217; CPT 99224- 99226)
All other services that were temporarily approved for CMS reimbursement will expire at the end of the PHE.
CMS Telehealth Expansion and Additional Providers
In addition, CMS approved the expansion of the type of provider covered for telehealth services.
This includes:
- Clinical social workers
- Clinical psychologists
- Physical therapists
- Occupational therapists
- Speech-language pathologists to deliver online assessment and management services, virtual check-ins, and remote evaluation services
For more information on the CMS telehealth expansion, please click here.
