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12/20/2020

New Telehealth Policies in Medicare 2021 Physician Fee Schedule

 

The changes for 2021 are designed to expand the use of telehealth technologies among Medicare beneficiaries.


The changes in the Final Rule include:

 


1. Direct Supervision via Telehealth

Until the end of the PHE (tentatively 1/21/2021) “direct supervision” can be provided using real-time, interactive audio-video technology. CMS will study and collect data on whether this change may be appropriate on a permanent basis after the PHE expires.


2. Extended Audio-Only Assessment Services: HCPCS G2252

On an interim basis for the duration of 2021, CMS created HCPCS code G2252 for extended services delivered via synchronous communications technology, including audio-only (e.g., virtual check-ins). The service is considered to be a communication technology-based service (CTBS) and is subject to all the other requirements of CTBS.


3. New Frequency Limitations for Telehealth in Nursing Facilities

CMS is reducing the frequency limitation for coverage of subsequent nursing facility care services furnished via telehealth from once every 30 days to once every 14 days.


4. Policies on Communications Technology Based Services

CTBS by Therapists. HCPCS codes G2061 through G2063 may be billed by licensed clinical social workers, clinical psychologists, physical therapists (PT), occupational therapists (OT), speech language pathologists (SLP), and other non-physician practitioners who bill Medicare directly for their services, when the service falls within the scope of the practitioner’s benefit category. This billing has been temporarily allowed under the PHE waivers, but this new rule change is permanent, effective January 1, 2021.


5. New Telehealth Services

CMS is permanently adding these codes for permanent additions to the Medicare Telehealth service list:


The phone calls 99441, 99442 and 999443 will continue to be paid until the PHE is over (tentatively 1/21/2021) unless it is extended.  CMS states it does not have the authority to pay for audio-only E&M services after expiration of the PHE. CMS established new coding and payment, outside of the PHE, for an extended audio-only virtual check-in service (HCPCS code G2252). CMS did not propose or finalize any changes to the originating site requirement. When the PHE expires, telehealth services will again only be available to beneficiaries in rural areas who travel to an originating site to receive the telehealth service, with some exceptions.


 

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