If you are hoping the Centers for Medicare & Medicaid Services (CMS) will throw caution to the wind and spearhead the telehealth movement, think again. Based on the 2017 Medicare Physician Fee Schedule (MPFS) Final Rule, unless pressed by lawmakers, they are going to take their time adding to this line of coverage.
There are just a few changes for 2017 reporting of telehealth services of which providers and their medical coding and billing staff should be aware. For Medicare Part B claims, you have a handful of new codes added to the list of payable telehealth services and a new place of service (POS) code.
Added Telehealth Services for 2017
CMS received several requests in 2015 to add various existing services as Medicare covered telehealth services effective for 2017. They finalized four CPT® codes:
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); and
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).
As a condition of payment, the required clinical examination of the catheter access site must be furnished face-to-face “hands on” (without the use of an interactive telecommunications system) by a physician, certified nurse specialist, nurse practitioner, or physician assistant.
New Codes for Critical Care Consultations
CMS also determined that two advance care planning codes (99497 and 99498) are similar to the two annual wellness visit codes (G0438 and G0439). As such, CMS added two new HCPCS Level II codes:
G0508 Telehealth consultation, critical care, physicians typically spend 60 minutes communicating with the patient via telehealth (initial); and
G0509 Telehealth consultation, critical care, physicians typically spend 50 minutes communicating with the patient via telehealth (subsequent)
This new coding provides a mechanism to report an intensive telehealth consultation service, initial or subsequent, for the critically ill patient, such as a stroke patient, under the circumstance when a qualified healthcare professional has in-person responsibility for the patient, but the patient benefits from additional services from a distant-site consultant specially trained in providing critical care services.
These services are limited to once per day, per patient; and are valued relative to existing evaluation and management services.
A New POS Code
Effective Jan. 1, 2017, physicians and practitioners furnishing telehealth services are required to report POS code 02 The location where health services and health related services are provided or received through telecommunication technology to indicate that the billed service is furnished as a telehalth service from a distant site.
This POS code does not apply to originating sites billing the facility fee. Originating sites are not furnishing a service via telehealth since the patient is physically present in the facility. Accordingly, the originating site should continue to use the POS code that applies to the type of facility where the patient is located.
Distant site providers are paid using the facility physician expense relative value units, regardless of their location. The setting of the patient does not affect the payment to the distant site provider.
Report POS code 02 in addition to the GT and GQ modifiers. CMS notes in the final rule that this may be redundant, and will consider removing the GT and GQ modifiers.
Several conditions must be met for Medicare to make payments for telehealth services under the MPFS. The service must be on the list of Medicare telehealth services and meet all of the following additional requirements:
- The service must be furnished via an interactive telecommunications system.
- The service must be furnished by a physician or other authorized practitioner.
- The service must be furnished to an eligible telehealth individual.
- The individual receiving the service must be located in a telehealth originating site.
When all of these conditions are met, Medicare pays a facility fee to the originating site and makes a separate payment to the distant site practitioner furnishing the service.