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Major Change in Medicare Telehealth Coverage

Medicare to Cover Audio-Only Telehealth
at In-Person Rates, Makes it Retroactive

Yesterday, in response to efforts by organized medicine, the Centers for Medicare & Medicaid Services (CMS) sent out a press release indicating they will be increasing payments for audio-only telephone visits for established patients between Medicare beneficiaries and their physicians to match payments for similar office and outpatient visits.

Highlights Include:

  • CMS is waiving the video requirement for certain telephone E/M services, and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services. This would increase payments for these services from a range of $14-$41 to $46-$110. The payments are retroactive to March 1, 2020. This applies to established patients only. The full list can be found on the CMS telehealth-eligible code list.

  • For telehealth services other than CPT codes 99441-99443 and 98966-98968 (now added to the list of covered telehealth services), Medicare continues to require modalities that have BOTH audio and video.

  • Retroactive payment will be made automatically; providers do not need to do any extra paperwork for previous claims submitted.

  • On future claims, do not use any modifiers on these claims. Use the place of service that would have been used if the patient had been seen face-to-face (POS 11).

  • For the duration of the COVID-19 PHE, CMS will waive restrictions on which provider type can bill for telehealth services. Now, other practitioners besides physicians, nurse practitioners, and physician assistants can bill for telehealth. This includes physical therapists, occupational therapists, and speech language pathologists.

Code Details:

These codes are used to report non-face-to-face patient services initiated by an established patient via the telephone. These are time-based codes, and time spent with the patient must be documented in the medical record. These codes should not be reported if the provider decides to see the patient within 24 hours or by the next available urgent visit appointment; if the provider performed a related E/M service within the previous seven days; or the call is initiated within a postoperative period.

There are some additional circumstances where Medicare and other payers may not reimburse separately for these telehealth services. Check with the specific payer to determine coverage. Do not report 99441-99443 when the same provider has reported 99421-99423 for the same problem in the previous seven days. For non-physician telephone medical services, see 98966-98968. Do not report these services when performed concurrently with other billable services, such as 99339-9934099374-9938099487-99489, or 99495-99496. Do not report these services for INR monitoring when reporting 93792 or 93793.

We know there is a lot of information here to digest, but we hope this information helps clarify some confusion around previous telehealth guidance. If you have questions about specific codes or coverage, contact CMS or the specific payer. As always, you can visit page for the latest guidance and updates.

If you have questions about this information
or OSMA’s services to physicians:

Call 800-766-6762 or email OSMA.

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