CMS Increases Telemedicine Reimbursement

There is good news for those who have had uncertainties over billing for telehealth procedures. At the start of November 2017, the Centers for Medicaid and Medicare Services (CMS) passed their final rules for the 2018 Quality Payment Program (QPP) and Physician Fee Schedule (PFS). Part of the update addresses the realities of natural disasters and other unavoidable circumstances. But, perhaps the most important things from a healthcare provider perspective are the addition of new telehealth CPT billing codes and a reduction in the reporting burden. So, that means more money for care providers and less administrative work to get it while providing more care options to their patients.

In addition to the increase of 0.41% in reimbursement values, the updates remove much of the ambiguity in telehealth billing. Before, CMS had different telehealth rates and codes for both Medicare and Medicaid, as did most private insurers. With a standardization of these rates and codes, many of the logistical roadblocks to adding telehealth to a healthcare practice are gone.

Creating an Industry Standard

Though the published rules only technically apply to Medicare and Medicaid, it is standard among private insurers to adopt the same sets of codes so as to have an informal but widely used industry standard. Arriving at this kind of consensus by asking for input from all stakeholders has helped to ensure that the transition will be as smooth as possible. There may still be instances where a provider offers a platinum level plan with telehealth coverage and a bronze level plan without, but, where telehealth is included, the codes will at least all be the same.

Previously, many healthcare providers would use the same CPT codes to bill in-person and telehealth procedures that were otherwise identical. While a solid rule of thumb, this is not always the best idea. The expansion and standardization offered by the new final rules remove the uncertainty on whether or not this is the correct action by clearly defining telehealth procedures as having their own specific range of CPT codes independent of the ones used for in-person visits. The change has the added benefit of moving prices across the healthcare field toward a median figure, which benefits patients and insurers alike by knowing what their costs will be and healthcare providers by helping them know how much they will be paid. In one way or another, this is good for everyone involved.

A Look Ahead for Telemedicine Reimbursement

In short, yes, this is a rules change, and there are going to be some kinks to work out in the transition. Once the new rules are fully implemented in 2018, however, the standardization and clarification offered by these rules will more than make up for any difficulties encountered in the process.

New Update: Elimination of GT Modifier for Telehealth Services

As of January 1, 2018, Medicare is removing the requirement to use the GT modifier on professional claims for telehealth services.

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Avizia was acquired by Amwell in July of 2018. Information on this page refers to activities that occurred prior to the acquisition and are presented for historical context. Together we provide a comprehensive acute care offering—a full end-to-end telemedicine solution for health systems and their providers.