CMS Proposes Expanded Medicare Coverage for Telehealth

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Center for Medicare and Medicaid Services Proposes Increasing Telehealth Coverage for Services Beginning January 2017

The Center for Medicare and Medicaid Services (CMS) propose increasing telehealth coverage by 8 new Current Procedural Terminology (CPT) codes for services beginning January 1, 2017. This is part of the proposed rulemaking for Part B physician and practitioner services.

CMS proposes coverage for critical care evaluation and management, especially important for hospital patients in intensive or critical care units, using new temporary codes GTTT1 and GTTT2

The following proposed improvements are good news for patients with end-stage renal disease. The proposed codes are comparable to already covered services:

  • 90967: End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age;
  • 90968: End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 2-11 years of age;
  • 90969 - End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 12-19 years of age); and
  • 90970 - End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 20 years of age and older).

Two additional codes were proposed advanced care planning including the explanation and discussion of advance directives: 

  • 99497: Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), or surrogate);
  • 99498: Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (list separately in addition to code for primary procedure.)

In addition, CMS proposes lessening CPT code 99490 requirements for the initiating visit, 24/7 access to care and continuity of care, format and sharing of the care plan and clinical summaries, beneficiary receipt of the care plan, beneficiary consent, and documentation.  CMS believes the 99490 code is underutilized with 275,000 beneficiaries served an average of 3 months in 2015.

The proposed rulemaking is open for public comment through September 6. 

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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 please visit http://www.americantelemed.org

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Jessica Washington
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