December 02, 2020 – Telehealth and remote patient monitoring will see significant improvements in Medicare coverage in 2021.
The long-awaited 2021 Physician Fee Schedule, unveiled on Tuesday by the Centers for Medicare & Medicaid Services, aims to build upon the momentum for telehealth adoption seen during this year’s coronavirus pandemic. With health systems and hospitals rapidly embracing connected health, the agency has been under pressure to improve access and reimbursement guidelines.
While analyses of the final rules will come in over the next few days, here’s what CMS has included in its document.
The final rule begins with roughly 60 new telehealth services that can be reimbursed under Medicare, as follows:
Those services are included under Category 1, making coverage permanent. A separate group, called Category 3, reflects services that were included in emergency waivers issued during the past year to improve connected health coverage and adoption during the public health emergency created by the coronavirus pandemic. CMS has decided these services will continue to be reimbursed through the calendar year that the public health emergency concludes:
In addition, CMS will now cover one nursing facility visit via telehealth every 14 days, down from once every 30 days. Telehealth advocates had argued that the frequency limit should be reduced to once every three days or even eliminated altogether, but the agency noted that these patients require longer care than hospital patients, and that a lax policy on virtual visits could have a detrimental effect on in-person care.
In its final rule, CMS has expanded the list of care providers able to be reimbursed for using telehealth to include clinical social workers, clinical psychologists, physical and occupational therapists and speech language pathologists. The agency is adding two new billing codes so that these providers can bill for virtual check-ins and remote evaluation of patient-submitted video or images.
The agency is also noting that telehealth rules don’t apply if the provider and patient are in the same location, even if the provider is using telecommunications equipment to monitor a patient to, for example, avoid risk of exposure to COVID-19.
With regard to coverage for audio-only phone check-ins, CMS is creating a new code for 11-20 minutes spent on the phone to determine the necessity of in-person care. This reimbursement would be about half as much as equivalent in-person care.
With more healthcare providers looking to extend care into the home, CMS has been gradually expanding coverage for what it calls remote physiologic monitoring services, and the agency proposed significant changes in the initial PFS released in August. That coverage is now set in place with the 2021 PFS.
The following RPM rules are included in the final document:
In addition, CMS is expanding coverage for direct supervision through interactive communications technology, under the idea that providers can use telemedicine platforms to supervise others and monitor patients without being in the same room. To that end, the agency will allow coverage for direct supervision through real-time interactive audio-visual technology until the end of the PHE or 2021, whichever comes first.
Finally, in a press release accompanying the 2021 PFS, CMS announced that it will commission a study on telehealth use during the pandemic to “explore new opportunities for services where telehealth and virtual care supervision, and remote monitoring can be used to more efficiently bring care to patients and to enhance program integrity, whether they are being treated in the hospital or at home.”