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On Aug. 4, 2020, the Center for Medicare and Medicaid Services (CMS) published their CY 2021 proposed revisions related to the Physicians Fee Schedule (PFS). Comments on the proposals are due no later than 5 pm on October 5, 2020. The proposed PFS addresses some changes CMS made administratively as a result of the COVID-19 public health emergency (PHE), and proposes how these certain proposals will be dealt with on a provisional basis until the end of the PHE, and in some cases whether or not the policy will become permanent.  There are some temporary policy changes that occurred during the PHE, such as limitations around the eligible provider types and patient location, that require Congressional action to be made permanent, and are thus not addressed in CMS’ proposals.

For items related to telehealth, CMS is proposing to add certain select codes that are currently on the Medicare telehealth list as a result of the PHE, on a permanent basis.  CMS has an established process for adding codes to the list of Medicare telehealth services eligible for reimbursement. The process includes assigning qualifying requests to either one of two categories. Category 1 is reserved for services that are similar to services already approved on the Medicare telehealth list such as professional consultations, offi­ce visits and o­ffice psychiatry services. Category 2 (which entails a more extensive qualification process) is for services that are not similar to current telehealth services on the Medicare list, but pose a significant benefit for the patient. 

For CY 2021, CMS is proposing to add the following codes on a Category 1 basis:

  • GPC1X – Visit Complexity with certain office/outpatient evaluation and management services
  • 99XXX – Prolonged Services
  • 90853 – Group Psychotherapy
  • 96121 – Neurobehavioral Status Exam 
  • 99483 – Care Planning for Patients with Cognitive Impairment
  • 99334 – Domiciliary, Rest Home, or Custodial Care services
  • 99335 – Domiciliary, Rest Home, or Custodial Care services
  • 99347 & 99348 – Home Visits

They are also proposing to add additional codes provisionally which would be eligible for reimbursement until the end of the year in which the PHE ends, and would be classified as Category 3 (a newly created category).  

Category 3 additions would include:

  • 99336 & 99337 – Domiciliary, Rest Home, or Custodial Care services, Established patients
  • 99349, 99350 – Home Visits, Established Patients
  • 99281, 99282, 99283 – Emergency department Visits
  • 99315, 99316 – Nursing Facility discharge day management
  • 96130 – Psychological and Neuropsychological Testing
  • 96131, 96132, 96133 – Psychological testing evaluation services

To become permanent, they would ultimately need to meet the qualifications of Category 1 or 2, however allowing them to be provisionally allowed until the end of the year in which the PHE ends would give enough time for CMS to thoroughly assess the codes qualifications to be allowed permanently. Other codes that are currently eligible for telehealth reimbursement under the PHE would expire when the PHE ends.  CMS is soliciting comments on codes that are currently on the telehealth list during the PHE for COVID-19, but for which they have not been proposed to be added on a Category 1 or 3 basis.  Additionally, they are interested in comments regarding physical therapy, occupational therapy and speech language pathology codes, since those types of professionals are not eligible to provide those services under current statute, although they could potentially be billed as ‘incident to’ by a physician or other eligible practitioner.

Although CMS is proposing to remove the exclusion of telephones, facsimile machines and electronic mails systems from the definition of an ‘interactive telecommunication system’, they are not proposing to continue reimbursement for telephone codes (99441-99443).  However, they are seeking comment on whether CMS should develop alternate coding and payment for a service similar to the virtual check-in but for a longer unit of time and with a higher value and whether telephone-only services should be provisional policy during the PHE or if it should become a permanent payment policy. 

CMS has also made clarifications and modifications around remote physiologic monitoring and regarding the ability of clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists to furnish brief online assessment and management services, virtual check-ins and remote evaluation. Requests for comments and proposals also relate to supervision requirements, as well as requirements for residents and teaching physicians.  Additional telehealth-related policy proposals and requests for comments are prevalent throughout the proposed PFS.

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