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The Centers for Medicare and Medicaid Services (CMS) is preparing to eliminate the majority (74) of the temporary telehealth CPT codes created during the pandemic once the public health emergency (PHE) ends. It is, however, adding 13 new codes, and keeping 9 codes added during the COVID-19 emergency.
The 13 new codes to be added are placed in a new category, Category 3. Category 1 CPT codes will remain, but Category 2 CPT codes are scheduled for elimination at the end of the PHE. The new Category 3 CPT codes will stay in force through the end of the PHE, and are an effort by CMS to expand telehealth coverage, while it looks for evidence to support them. CMS believes these codes could be added on a permanent basis, but require more use and feedback from stakeholders before they can make a final determination.
CMS Looking for Evidence to Support Telehealth CPT Codes
The public has an opportunity to provide feedback and submit requests to CMS to add some of these Category 3 telehealth CPT codes to Medicare telehealth services permanently. CMS is looking for the public to provide relevant clinical studies that show that the service delivered by telehealth improves diagnosis, treatment or improves the functioning of a malformed body part. CMS is soliciting published, peer-reviewed articles regarding the same as well.
Who’s in Charge of Telehealth CPT Codes: CMS, Executive Order, Congress or All?
President Trump’s executive order, (see President Issues Executive Order on Improving Rural Health and Telehealth Access) which has a 60-day limit, requires the Department of Health and Human Services Secretary to propose a regulation to extend some or all of CMS’s emergency telehealth measures including telehealth CPT codes “as appropriate during the duration” of the public health emergency. Further, Congress has the ability to make more dramatic changes to coverage and telehealth billing codes, but due to the current political environment and the extraordinary number of proposed bills addressing telehealth, (see Telehealth Act HR 7992 Telehealth Legislation Combines Nine Separate Bills) it’s difficult to predict an outcome with any sense of certainty. Some changes may be included in the next stimulus bill and others may be separate legislation.
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What are the proposed codes to be eliminated? Which codes are being kept and what are the new codes being proposed?
I was expecting to see the actual codes!
Lois,
As a free publication, we are limited to sharing the information that we find online. In this case, however, we had so many people who like you, want additional info that we’ve taken the time do a little more legwork for you. We ran a quick web search for Level I CPT code and found this description:
What Are the Three Categories of CPT Codes? The three categories of CPT codes are as follows:
Category I: Most coders spend the majority of their time working with Category I codes. There are different sections of these codes, based on the field of health care. The six sections of the CPT codebook are Evaluation and Management, Medicine, Surgery, Radiology, Anesthesiology and Pathology and Laboratory. Each field has a unique set of guidelines. The CPT codes under Category I are five digits long.
Category II: Category II codes contain four digits, followed by the letter F. Category II codes are optional. They provide additional information and are not a replacement for Category I or Category III codes.
Category III: Category III codes are temporary, and represent new or experimental procedures or technology. For example, if you can’t find a new procedure in Category I, you might use a Category III code. Category III codes are four digits long and end in the letter T.
Since Category I is the most frequently used, here’s a look at the numerical range of codes within this category.
Evaluation and Management: 99201 to 99499
Anesthesia: 00100 to 01999 and 99100 to 99140
Surgery: 10021 to 69990
Radiology: 70010 to 79999
Pathology and Laboratory: 80047 to 89398
Medicine: 90281 to 99199 and 99500 to 99607
This information comes from https://www.icanotes.com/2019/02/27/cpt-code-basics-what-you-should-know/#What Are the Three Categories of CPT Codes.
For behavioral professionals, Evaluation and management from CPT Code Level I is the most relevant. The article that we cited then, suggests that currently used codes are not likely to change after COVID. However, we at TBHI are not in control of these codes, so please do not hold us responsible if the article is incorrect or if CMS changes its mind. We will, however, make an effort to post any other developments that we can find. We ask you to help us, too. Our newsletter and blog are community services that are self-supported with the help of a few well-chosen advertisers. Your active participation is needed to make this labor-of-love viable for us all.
Thank you
Thank you for this article.
Do you have a reference/link to the list of codes that would be eliminated? And which ones would be added in the different categories?
Please add links to this article so we may see the actual codes and know where to go to comment on the government website.
so which codes are being impacted?
It’s the 21 Century. Technology is only getting better. People are only getting busier. Telehealth is the future, especially in the area of mental health. Those impaired individuals who may need help the most, appear to be gravitating toward reaching out through the smart phones or their computers. COVID-19 has highlighted this need, and now is the time to ensure its continued use.