New CPT codes have been approved for telehealth. In Medicare’s 2014 physician fee schedule, the Centers for Medicare and Medicaid Services outlined several new telehealth services and service regions that will be reimbursed by the federal government starting 2014. These changes include new services for mental health providers.
CMS is expanding the geographic areas where Medicare will cover telehealth into the “the fringes of metropolitan areas,” as noted by the American Telemedicine Association (ATA).
CPT Codes & Other Supportive Changes
According to the ATA, other substantial changes that further support telehealth include:
- Adding coverage for transitional care management services (CPT codes 99495 and 99496) and making explicit that coverage includes the Evaluation and Management portion of these services;
- Adding coverage for chronic care services (CPT codes 99487-99489) for patients with multiple chronic conditions that are expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. These services are for a patient whose medical and/or psychosocial problems require moderate or high complexity medical decision-making during transitions in care from an inpatient hospital setting.
Facility Fees Increase
Medicare also provides payment of a facility fee to approved originating sites. That typical telehealth originating site facility fee is increased to $24.63.
Use Modifer Codes
Add modifier “9r “Interactive audio and video telecommunications systems to the procedure codes when billing to indicate the use of telecommunications services.
Adding new CPT Codes
Every year, CMS solicits requests to add services to the list of Medicare telehealth services. The deadline to submit requests is December 31 for the next rulemaking cycle. For instructions, visit CMS website here.
How Can I Get Paid More for Telehealth?
Increase your telehealth revenue. Industry leaders explain how, when, and why to use telehealth CPT codes and modifiers.