Medicare May Expand Payment for Telemedicine Services

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MedicareUnder a proposed rule setting the Part B physician fee schedule for calendar year 2015, Medicare would expand payment for certain medical and mental health services furnished via telemedicine technologies.

“We are proposing to add the following services to the list of services that can be furnished to Medicare beneficiaries under the telehealth benefit: annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services,” the Centers for Medicare and Medicaid Services says in the proposed rule, available here and being published July 11 in the Federal Register.

Specifically, the new mental health services proposed for payment are CPT codes 90845 (psychoanalysis), 90846 (family psychotherapy without the patient present), and 90847 (family psychotherapy: conjoint psychotherapy with patient present).

Telemedicine-enabled medical services for payment being proposed are CPT codes 99354 (prolonged service in the office or other outpatient setting requiring direct patient contact beyond the first service; first hour listed separately in addition to code for office or other outpatient evaluation and management service); and, 99355 (prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service: each additional 30 minutes listed separately in addition to code for prolonged). Also: HCPCS codes G0438 (annualized wellness visit including a personalized prevention plan of service in an initial visit); and, G0439 (annual wellness visit including a personalized prevention plan of service in a subsequent visit).

In general, CMS requires a Medicare telehealth service be conducted with an interactive telecommunications system that at minimum includes two-way audio/video real-time interactive communication between the patient and the distant site clinician. That rules out telephone, fax machine and email communications. However, use of store-and-forward technology which is the transmission of information to a provider to be reviewed at the distant site at a later time is permitted for federal telemedicine demonstration programs in Alaska and Hawaii.

“Medicare telehealth services may be furnished to an eligible telehealth individual notwithstanding the fact that the practitioner furnishing the telehealth service is not at the same location as the beneficiary,” the rule clarifies. “An eligible telehealth individual means an individual enrolled under Part B who receives a telehealth service at an originating site.”

CMS received requests to permit payment for a number of medical imaging services, particularly electrocardiogram and echocardiography procedures, as well as several mental health treatments and certain gynecological services. The agency declined as these services do not meet criteria for listing on the Medicare telehealth list.

Further, “The American Telemedicine Association cited several studies to support adding dermatology services to the telehealth list, however, the request did not include specific codes,” CMS noted in the proposed rule. “Since we did not have specific codes to consider for this request, we cannot evaluate whether the services are appropriate for addition to the Medicare telehealth services list. We note that some of the services that the requester had in mind may be billed under the telehealth office visit codes or the telehealth consultation G-codes.”

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