Please listen to our podcast on COVID-19, telehealth, reimbursements, billing, and our response.
Please download our summary of coding and reimbursement during the COVID-19 pandemic:
For a comprehensive summary of the changes to telemedicine, including billing changes, applicable during the COVID-19 public health emergency, please download the following bulletin:
CMS Billing Tip: CMS will pay at the professional (higher) rate for telemedicine visits if the service is billed using the Place of Service (POS) 11 - Physicians' Office. CMS is requesting that you append the -95 modifier to indicate that it was a service performed via telemedicine. Do NOT use POS -02 as it will be paid at the lower, facility rate.
A: On April 30, CLIA issued comprehensive guidance that includes types of tests, where to order and perform tests, and how to bill COVID-19 tests.
A: This CMS document shows under the header “Virtual Check-Ins & E-Visits” the appropriate billing codes to use for patient engagements via the telephone. For telephone evaluation and management services provided by a physician (CPT 99441-99443) and telephone assessment and management services provided by a qualified nonphysician healthcare professional (CPT 98966-98968). These codes are only available to established patients but may be furnished using audio-only devices.
NEW INFORMATION (4/30/2020): CMS increases payment for audio only phone calls to match office visit codes. The regulations have not been posted yet. That should come out in the next couple of days.
CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.
A: The Trump Administration expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of health care services from their doctors without having to travel to a health care facility. Beginning on March 6, 2020, Medicare—administered by CMS—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.
CMS has several FAQs related to services associated with the COVID-19 pandemic answered in this document.
Many private health insurance plans have followed this movement and eased restrictions to facilitate care during this public health emergency. Coverage, rules, and guidelines are continually evolving and are benefit plan and payer specific. It is recommended to check with your payers on their specific telemedicine payment and policy guidelines.
A: See Cost-sharing at the bottom of page 3 for specific modifier use: https://www.cms.gov/files/document/se20011.pdf. Also, continue to look at specific payer sites for billing updates. For example, Cigna wants the CS and specific diagnosis, and other payers may have specific requirements (links provided below).
SUMMARY: We are changing Medicare payment rules during the Public Health Emergency (PHE) for the COVID–19 pandemic so that physicians and other practitioners, home health and hospice providers, inpatient rehabilitation facilities, rural health clinics (RHCs), and federally qualified health centers (FQHCs) are allowed broad flexibilities to furnish services using remote communications technology to avoid exposure risks to health care providers, patients, and the community. We are also altering the applicable payment policies to provide specimen collection fees for independent laboratories collecting specimens from beneficiaries who are homebound or inpatients (not in a hospital) for COVID–19 testing. We are also expanding, on an interim basis, the list of destinations for which Medicare covers ambulance transports under Medicare Part B. In addition, we are making programmatic changes to the Medicare Diabetes Prevention Program (MDPP) and the Comprehensive Care for Joint Replacement (CJR) Model in light of the PHE, and program-specific requirements for the Quality Payment Program to avoid inadvertently creating incentives to place cost considerations above patient safety. This IFC will modify the calculation of the 2021 and 2022 Part C and D Star Ratings to address the expected disruption to data collection and measure scores posed by the COVID–19 pandemic and also to avoid inadvertently creating incentives to place cost considerations above patient safety. This rule also amends the Medicaid home health regulations to allow other licensed practitioners to order home health services, for the period of this PHE for the COVID–19 pandemic in accordance with state scope of practice laws. We are also modifying our under arrangements policy during the PHE for the COVID– 19 pandemic so that hospitals are allowed broader flexibilities to furnish inpatient services, including routine services outside the hospital.
A: This link provides the latest information for properly billing for COVID-19 related healthcare services. The World Health Organization (WHO) established a new diagnosis code U07.1 for COVID-19. The original effective date was set for October 1, 2020. Given the urgent need to capture reporting of this condition, the Centers for Disease Control (CDC), changed the effective date of the new diagnosis to April 1, 2020.