Telemedicine gaining acceptance among payors


Although not entirely embraced by insurers, telemedicine is slowly becoming a more acceptable means of providing care. Even the federal government is starting to recognize telemedicine’s benefits.

Earlier this month, The Centers for Medicare & Medicaid Services (CMS) proposed increasing telehealth coverage by adding new CPT codes for services beginning January 1, 2017 as part of the proposed rulemaking for Part B physician and practitioner services.

Four of the proposed codes relate to end-stage renal disease care:

  • 90967: End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age
  • 90968: End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 2-11 years of age
  • 90969 – End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 12-19 years of age)
  • 90970 – End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 20 years of age and older)

In recommending the codes be added, CMS stated: “Of the requests received, we found that four services were sufficiently similar to ESRD-related services currently on the telehealth list to qualify on a category 1 basis.â€

Although CMS said it did not receive a specific request, it proposed adding two more CPT codes relating to advanced care planning stating: “We have determined that these services are similar to the annual wellness visits (HCPCS codes G0438 & G0439) currently on the telehealth list.â€

  • 99497: Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), or surrogate)
  • 99498: Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (list separately in addition to code for primary procedure)

CMS is also proposing payment policies related to the use of new place of service code specifically designed to report services furnished via telehealth.

Last month, the American Medical Association adopted ethical guidance related to the practice of telemedicine and telehealth. In issuing the guidelines, the AMA stated:

“The evolution of telehealth and telemedicine capabilities offers increasingly sophisticated ways to conduct patient evaluations as technologies for obtaining patient information remotely continue to evolve and improve. The AMA guidelines permit physicians utilizing telehealth and telemedicine technology to exercise discretion in conducting a diagnostic evaluation and prescribing therapy, within certain safeguards.â€

Currently, Medicare treats telehealth almost exclusively as a tool for rural areas, and has narrowly restricted the geographic areas that are eligible to use telehealth.

However, as telemedicine continues to improve access to healthcare, care coordination and quality, as well as reduce the rate of growth in health care spending, we expect to see further favorable actions promoting its use.

Because this is a field that is changing, healthcare providers need to make sure they stay up-to-date with the latest changes in both the regulatory and payor arenas. The Healthcare Offices of Anthony C. Vitale can assist clients on issues relating to regulations, licensure, software agreements and reimbursements. Give us a call at 305-358-4500 or send an email to info@vitalehealthlaw.com

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