CMS boosts telehealth in 2015 physician pay schedule

From the mHealthNews archive
By Eric Wicklund

The Centers for Medicare and Medicaid Services unveiled some good news for telemedicine advocates this past weekend, including several provisions in its 2015 Medicare physician fee schedule that advance access to and reimbursement for telemedicine services.

In all, Medicare payments to telehealth originating sites will increase by 0.8 percent in 2015.

“This Halloween, Medicare beneficiaries got an important treat for home care of chronic care management, remote patient monitoring of chronic conditions and other services when provided via telehealth,” Jonathan Linkous, CEO of the American Telemedicine Association, said in a press release trumpeting the new rules – for which the ATA has been lobbying CMS for more than five years. “It has been a long time coming, but this rulemaking signals a clear and bold step in the right direction for Medicare. This allows providers to use telemedicine technology to improve the cost and quality of healthcare delivery.”

[See also: Do doctors have the right 'bedside manner' for telehealth?]

Almost lost in the 1,200-page rulemaking document, CMS has included provisions paying for remote chronic care management using the new CPT (current procedural terminology) code of 99490, with a monthly unadjusted non-facility fee of $42.60. In addition, CPT code 99091 allows providers to be reimbursed by Medicare for remote patient monitoring of chronic conditions through a monthly unadjusted non-facility fee of $56.92.

According to the ATA, Medicare hasn't paid separately for these services in the past, forcing providers to bill such services under the "evaluation and management" code.

The rules also list seven new covered procedure codes for telehealth, according to the ATA, including annual wellness visits, psychotherapy services and prolonged services in the office.

According to Politico, not all the news was telemedicine-friendly. CMS didn't adhere to the wishes of some stakeholders who wanted a provision dropped that requires patients to be in a rural location to receive billable telemedicine services.

"We do not have authority to implement many of these revisions under the current statute," CMS stated in its rule, as reported by Politico. "The CMS Innovation Center is responsible for developing and testing new payment and service delivery models to lower costs and improve quality for Medicare, Medicaid and CHIP beneficiaries. As part of that authority, the CMS Innovation Center can consider potential new payment and service delivery models to test changes to Medicare's telehealth payment policies."

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