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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:
A: Yes, if certain criteria are met. Follow these links for additional information:
A: To provide support to health care providers for COVID-19 testing and treatment for uninsured individuals with a COVID-19 diagnosis, the U.S. Department of Health and Human Services will provide reimbursement, generally at Medicare rates. For more information about how the program works go to https://www.hrsa.gov/CovidUninsuredClaim.
A: According to the April 30, 2020 Interim Final Rule with comment, if the services described by code 99211 are provided to assess for COVID-19 and specimen collection, 99211 can be billed. The code can be billed for both new and established patients. Direct supervision for the specimen collection can be met by virtual presence of the supervising physician or practitioner with interactive audio or video technology.
A: Previously “typical time” was defined as all of the time associated with the E/M on the day of the encounter. The “typical times” were available in a public file and were not the times listed in the office/outpatient E/M code descriptors. These discrepancies were causing confusion. Now “typical times” for the selection of an E/M level will be the times listed in the code descriptors.
A: CMS has instructed the Medicare Administrative Contractors (MAC) to make claim adjustments, and there is no need to resubmit. Claims, for dates of service March 1, 2020 and after, that were submitted and not covered, will be reprocessed by your MAC. If the claim was paid at the lower rate, they will reprocess with the increased allowance. These claim adjustments will take place in stages.
A: Please see the CMS document regarding modifier usage.
A: Issued on May 27, 2020, CMS compiled a comprehensive list of their FAQs in one document.
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.
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: Coverage, rules, and guidelines for telehealth are continually evolving and are benefit- and payer-specific. We recommend you check with your payers on their specific telemedicine payment and policy guidelines. These AMA documents provide some helpful coding advice.
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.
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.
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