Category: Current Procedural Terminology (CPT®) code set

Executive Summary: Tracking Telehealth Changes State-by-State in Response to COVID-19 – September 2020

As the COVID-19 pandemic continues across the United States, states, payers, and providers are looking for ways to expand access to telehealth services. Telehealth is an essential tool in ensuring patients are able to access the healthcare services they need in as safe a manner as possible. In order to...

CMS Proposes Significant Changes to Remote Patient Monitoring Coverage

The Centers for Medicare & Medicaid Services has clarified how providers can use telehealth and mHealth to establish and run remote patient monitoring programs, with changes that some feel could hinder care at home.  By Eric Wicklund September 01, 2020 – The federal government is clarifying how it regulates remote patient monitoring,...

MedPAC commissioners hint at telehealth policies that may stick post-COVID-19

Dive Brief: Members of the congressional advisory group Medicare Payment Advisory Commission agree telehealth is here to stay, but are concerned about how to improve access without also running up substantial costs in the Medicare program. The group weighed various Medicare telehealth payment policies that could become permanent after...

CMS Releases E&M Updates, Expands Telehealth, Makes ACO Changes

Among the changes announced this week include the expanded use of telehealth in Medicare, giving payment parity to hospital outpatient surgery centers, simplifying evaluation and management codes, and changing performance measures for accountable care organizations (ACOs). Among a swath of proposed policy and payment changes announced this week by...

Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021

On August, 3 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2021. The calendar year (CY)...

Top 10 Medicare Remote Patient Monitoring (RPM) FAQs for 2021

On August 3, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a number of clarifications and proposals on remote patient monitoring (RPM) services reimbursed under the Medicare program. The changes, part of the advance copy of CMS’ proposed 2021 Physician Fee Schedule, are intended to clarify CMS’ position...

Telehealth Coding Guide for Billing

There’s nothing more frustrating than rendering a service and not being paid. Nuanced coding rules are difficult to understand, and physicians aren’t taught this information in medical school. Still, health care is a business. As business owners, physicians need to know how they’re paid, including what codes to use,...

CMS Proposes New Medicare Changes in Telehealth for 2021

On August 3, 2020, the Centers for Medicare and Medicaid Services (CMS) issued the advance copy of its proposed 2021 Physician Fee Schedule rule, which contains new telehealth services covered under Medicare.  Compared to last year, where CMS made only minor additions to telehealth services, the changes proposed for 2021 are bold...

Proposed Policy, Payment, and Quality Provisions Could Bring Changes to the Medicare Physician Fee Schedule for Calendar Year 2021

On August, 3 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2021. The calendar year (CY)...

Proposed Policies for the Medicare Diabetes Prevention Program Expanded Model (MDPP) for the Calendar Year 2021 Medicare Physician Fee Schedule

On August 3, 2020, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2021 Physician Fee Schedule (PFS) proposed rule, which proposes to revise certain MDPP policies during the remainder of the COVID-19 Public Health Emergency (PHE) and any future applicable 1135 waiver event. We...

How CMS Changes and Trump’s Executive Order Impact Telehealth Coverage in 2020 and Beyond

Alongside President Trump’s call for more rural telehealth coverage, CMS’ proposed 2021 Physician Fee Schedule could keep the momentum going for connected health. But is it enough? August 06, 2020 – The Centers for Medicare & Medicaid Services has come out with its long-anticipated plans to expand telehealth coverage beyond the...

A Quick Reference Guide to Remote Patient Monitoring During the COVID-19 Pandemic

Remote Patient Monitoring (RPM) is real-time or near real-time evaluation of a patient’s clinical status outside of a traditional healthcare setting. RPM leverages wireless devices (e.g., weight scale, blood pressure monitor), often integrated with a software platform, to monitor patients’ health status. Providers can use RPM to manage patients...

CMS Guidance for Remote Patient Monitoring (RPM) During COVID-19 (CPT Codes 99453, 99454, 99457, 99458, and 99091)

The Centers for Medicare & Medicaid Services (CMS) has provided some guidance within the “Medicare and Medicaid Programs Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency” interim final rule (IFR), allowing for remote patient monitoring, or RPM. This type of patient care is very helpful...
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