CMS Relaxed Regulatory Requirements for Physicians

April 30, 2020

On March 30, 2020, CMS published an interim final rule (Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency) to provide additional flexibility to physicians during the COVID-19 pandemic. The following changes are effective as of March 1, 2020, and for the duration of this current public health emergency.

  • Added Medicare coverage of, and payment for, telephone evaluation and management (E/M) services (CPT 99441-99443). These services may be provided to new or established patients.

  • Allows physicians to select the level of office/outpatient E/M furnished via Medicare telehealth based on medical decision making (MDM) or time.

  • Time is defined as all the time associated with the E/M on the day of the encounter. The current typical times associated with office E/M are what should be met for the purposes of level selection.

  • CMS is maintaining the current definition of MDM.

  • CMS has removed any requirements regarding documentation of history and/or physical exam in the medical record for such visits.

  • Clarifies the Office of Inspector General’s (OIG) Policy Statement to state that physicians will not be subject to sanctions for reducing or waiving cost-sharing for a broad category of non-face-to-face services, including:

  • telehealth visits

  • virtual check-in services

  • e-visits

  • monthly remote care management

  • monthly remote patient monitoring

  • Expands the list of services that can be provided via telehealth. The updated list can be found here.

  • Provides payment for telehealth services at the non-facility rate under the Medicare physician fee schedule when appropriate

  • Physicians must bill the telehealth service with the Place of Service (POS) code they would have used if the service had been provided in person. Physicians must also append modifier -95 to the claim lines that describe services delivered via telehealth.

  • Any service reported with POS 02 (Telehealth) will be paid at the facility rate under the Medicare physician fee schedule.

  • Allows telehealth, virtual check-ins, e-visits, and telephone E/M services to be provided to any patient — new or established.

  • Clarifies that consent must be obtained annually and may be obtained either before or at the time of service.

  • For Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) — expands the services included in Virtual Communication Services (HCPCS G0071) to include the services reflected in CPT 99421-99423.

  • CMS will revise the payment amount of G0071 to the average national non-facility amount for HCPCS G2012 and G2010 and CPT 99421-99423.

  • All virtual communication services billable using HCPCS code G0071 will also be available to new patients that have not been seen in the RHC or FQHC within the previous 12 months.

     

     

     

     

     

     

     

     

     

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