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Telehealth and Audio-Only Visits: What’s New for Medicare Patients and Providers

05.07.2020

The Centers for Medicare and Medicaid Services (CMS) defines “telehealth” services as audio and visual communication between a patient and a “distant site provider.” Previously, only established patients in rural areas and located in an authorized “originating site” could receive telehealth services. Originating sites include hospitals, skilled nursing facilities, physician offices, among others. To qualify as an originating site, the distant site provider must be in a separate location.

What’s New for Telehealth

For the duration of the Public Health Emergency (PHE), patients located in any area can receive telehealth services. This waiver applies to both established and new patients of the distant site provider. For the duration of the PHE, distant site providers will be paid at the same rate as if the services had been provided in-person. CMS is also allowing providers to waive the co-pay and deductible requirements for patients.

In addition, patients can receive telehealth services in their home, eliminating the requirement for them to be at an authorized originating site. CMS has also clarified that distant site providers can provide the service from their home without changing the place of service for billing purposes.

Originating sites can now also be outside rural areas. Hospitals, skilled nursing facilities and physician offices can bill and receive payment as originating sites. The distant site provider cannot be at the originating site.

What’s New for Audio-Only Services

Prior to the PHE, CMS did not reimburse providers for audio-only (phone calls) services.

For the duration of the PHE, CMS will reimburse physicians and other qualified providers for audio-only services to a new or established patient. The call must not be a result of a patient visit within the seven previous days or that result in a visit within 24 hours of the call.

On March 30, 2020, when these services were added by CMS, the national average payment was set at:

99441              5-10 minutes                           $14.41

99442              10-20 minutes                        $28.15

99443              > 20 minutes                           $41.14

On May 1, 2020, CMS announced an increase in these rates to:

99441              5-10 minutes                           $46.19

99442              10-20 minutes                        $76.15

99443              > 20 minutes                           $110.43

To date, CMS has NOT authorized the waiver of patient co-pays and deductibles for audio-only services.

We will continue to keep you updated as more changes occur. If you have any questions in the meantime, please contact Mark Renken, Health Care Advisory Director, at mrenken@bswllc.com or 636.754.0234.

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