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MLN Booklet TELEHEALTH SERVICES ICN MLN901705 March 2020 Target Audience: Medicare Fee-For-Service Providers The Hyperlink Table, at the end of this document, provides the complete URL for each hyperlink. TABLE OF CONTENTS Originating Sites…………………………………………………………………………………………………………………. 3 Distant Site Practitioners…………………………………………………………………………………………………….. 4 Telehealth Services …………………………………………………………………………………………………………….. 4 Telehealth Services Billing and Payment……………………………………………………………………………… 7 Telehealth Originating Sites Billing and Payment…………………………………………………………………. 8 Resources ………………………………………………………………………………………………………………………….. 8 Helpful Websites…………………………………………………………………………………………………………………. 9 Regional Office Rural Health Coordinators ………………………………………………………………………….. 9 CPT codes, descriptions and other data only are copyright 2018 American Medical Association. All Rights Reserved. Applicable FARS/HHSAR apply. CPT is a registered trademark of the American Medical Association. Applicable FARS/ HHSAR Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Page 1 of 9 Telehealth Services MLN Booklet Page 2 of 9 ICN MLN901705 March 2020 CMS Alert! Medicare Beneficiaries Expanded Telehealth Benefits During COVID-19 Outbreak Under the Coronavirus Preparedness and Response Supplemental Appropriations Act and Section 1135 waiver authority, the Centers for Medicare & Medicaid Services (CMS) broadened access to Medicare telehealth services, so beneficiaries can get a wider range of services from their doctors and other clinicians without traveling to a health care facility. On March 6, 2020, Medicare began temporarily paying clinicians to furnish beneficiary telehealth services residing across the entire country. Before this announcement, Medicare could only pay clinicians for telehealth services, such as routine visits in certain circumstances. For example, the beneficiary getting the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary generally could not get telehealth services in their home. Under this Section 1135 waiver expansion, a range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, can offer a specific set of telehealth services. The specific set of services beneficiaries can get include evaluation and management visits (common office visits), mental health counseling, and preventive health screenings. Beneficiaries can get telehealth services in any health care facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes. This change broadens telehealth flexibility without regard to the beneficiary’s diagnosis, because at this critical point it is important to ensure beneficiaries follow CDC guidance including practicing social distancing to reduce the risk of COVID-19 transmission. This change will help prevent vulnerable beneficiaries from unnecessarily entering a health care facility when clinicians can meet their needs remotely. To read the Fact Sheet on this announcement visit: https://www.cms.gov/newsroom/factsheets/medicare-telemedicine-health-care-provider-fact-sheet To read the Frequently Asked Questions on this announcement visit: https://www.cms.gov/ files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf Telehealth Services MLN Booklet Learn about these Medicare telehealth services topics: ● Originating sites ● Distant site practitioners ● Telehealth services ● Telehealth services billing and payment ● Telehealth originating sites billing and payment ● Resources ● Helpful websites and Regional Office Rural Health Coordinators Medicare pays for specific (Part B) physician or practitioner services furnished through a telecommunications system. Telehealth services substitute for an in-person encounter. ORIGINATING SITES An originating site is the location where a Medicare beneficiary gets physician or practitioner medical services through a telecommunications system. The beneficiary must go to the originating site for the services located in either: ● A county outside a Metropolitan Statistical Area (MSA) ● A rural Health Professional Shortage Area (HPSA) in a rural census tract The Health Resources and Services Administration (HRSA) decides HPSAs, and the Census Bureau decides MSAs. To see a potential Medicare telehealth originating site’s payment eligibility, go to HRSA’s Medicare Telehealth Payment Eligibility Analyzer. Providers qualify as originating sites, regardless of location, if they were participating in a Federal telemedicine demonstration project approved by (or getting funding from) the U.S. Department of Health & Human Services as of December 31, 2000. Beginning July 1, 2019, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act removes the originating site geographic conditions and adds an individual’s home as a permissible originating telehealth services site for treatment of a substance use disorder or a co-occurring mental health disorder. Each December 31 of the prior calendar year (CY), an originating site’s geographic eligibility is based on the area’s status. This eligibility continues for a full CY. Authorized originating sites include: ● Physician and practitioner offices ● Hospitals ● Critical Access Hospitals (CAHs) ● Rural Health Clinics ● Federally Qualified Health Centers ● Hospital-based or CAH-based Renal Dialysis Centers (including satellites) ● Skilled Nursing Facilities (SNFs) ● Community Mental Health Centers (CMHCs) Page 3 of 9 ICN MLN901705 March 2020 Telehealth Services MLN Booklet ● Renal Dialysis Facilities ● Homes of beneficiaries with End-Stage Renal Disease (ESRD) getting home dialysis ● Mobile Stroke Units Note: Medicare does not apply originating site geographic conditions to hospital-based and CAH-based renal dialysis centers, renal dialysis facilities, and beneficiary homes when practitioners furnish monthly home dialysis ESRD-related medical evaluations. Independent Renal Dialysis Facilities are not eligible originating sites. Beginning January 1, 2019, the Bipartisan Budget Act of 2018 removed the originating site geographic conditions and added eligible originating sites to diagnose, evaluate, or treat symptoms of an acute stroke. Go to MLN Matters® article, New Modifier for Expanding the Use of Telehealth for Individuals with Stroke to learn how to use the new modifier for billing. DISTANT SITE PRACTITIONERS Distant site practitioners who can furnish and get payment for covered telehealth services (subject to State law) are: ● Physicians ● Nurse practitioners (NPs) ● Physician assistants (PAs) ● Nurse-midwives ● Clinical nurse specialists (CNSs) ● Certified registered nurse anesthetists ● Clinical psychologists (CPs) and clinical social workers (CSWs) o CPs and CSWs cannot bill Medicare for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services. They cannot bill or get paid for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838. ● Registered dietitians or nutrition professional TELEHEALTH SERVICES You must use an interactive audio and video telecommunications system that permits real-time communication between you at the distant site, and the beneficiary at the originating site. Transmitting medical information to a physician or practitioner who reviews it later is permitted only in Alaska or Hawaii Federal telemedicine demonstration programs. CPT only copyright 2018 American Medical Association. All rights reserved. Page 4 of 9 ICN MLN901705 March 2020 Telehealth Services MLN Booklet CY 2019 Medicare Telehealth Services Service HCPCS/CPT Code Telehealth consultations, emergency department or initial inpatient G0425–G0427 Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs G0406–G0408 Office or other outpatient visits 99201–99215 Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days 99231–99233 Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days 99307–99310 Individual and group kidney disease education services G0420–G0421 Individual and group diabetes self-management training services, with a minimum of 1 hour of in-person instruction furnished in the initial year training period to ensure effective injection training G0108–G0109 Individual and group health and behavior assessment and intervention 96150–96154 Individual psychotherapy 90832–90838 Telehealth Pharmacologic Management G0459 Psychiatric diagnostic interview examination 90791–90792 End-Stage Renal Disease (ESRD)-related services included in the monthly capitation payment 90951, 90952, 90954, 90955, 90957, 90958, 90960, 90961 End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents 90963 End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 2–11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents 90964 End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 12–19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents 90965 End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 20 years of age and older 90966 End-Stage Renal Disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age 90967 End-Stage Renal Disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients 2–11 years of age 90968 CPT only copyright 2018 American Medical Association. All rights reserved. Page 5 of 9 ICN MLN901705 March 2020 Telehealth Services MLN Booklet CY 2019 Medicare Telehealth Services (cont.) Service HCPCS/CPT Code End-Stage Renal Disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients 12–19 years of age 90969 End-Stage Renal Disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients 20 years of age and older 90970 Individual and group medical nutrition therapy G0270, 97802–97804 Neurobehavioral status examination 96116 Smoking cessation services G0436, G0437, 99406, 99407 Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services G0396, G0397 Annual alcohol misuse screening, 15 minutes G0442 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes G0443 Annual depression screening, 15 minutes G0444 High-intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes G0445 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes G0446 Face-to-face behavioral counseling for obesity, 15 minutes G0447 Transitional care management services with moderate medical decision complexity (face-to-face visit within 14 days of discharge) 99495 Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge) 99496 Advance Care Planning, 30 minutes 99497 Advance Care Planning, additional 30 minutes 99498 Psychoanalysis 90845 Family psychotherapy (without the patient present) 90846 Family psychotherapy (conjoint psychotherapy) (with patient present) 90847 Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour 99354 Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes 99355 Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; first hour (list separately in addition to code for inpatient evaluation and management service) 99356 CPT only copyright 2018 American Medical Association. All rights reserved. Page 6 of 9 ICN MLN901705 March 2020 Telehealth Services MLN Booklet CY 2019 Medicare Telehealth Services (cont.) Service HCPCS/CPT Code Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; each additional 30 minutes (list separately in addition to code for prolonged service) 99357 Annual Wellness Visit, includes a personalized prevention plan of service (PPPS) first visit G0438 Annual Wellness Visit, includes a personalized prevention plan of service (PPPS) subsequent visit G0439 Telehealth Consultation, Critical Care, initial, physicians typically spend 60 minutes communicating with the patient and providers via telehealth G0508 Telehealth Consultation, Critical Care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth G0509 Counseling visit to discuss need for lung cancer screening using low dose CT scan (LDCT) (service is for eligibility determination and shared decision making G0296 Interactive Complexity Psychiatry Services and Procedures 90785 Health Risk Assessment 96160, 96161 Comprehensive assessment of and care planning for patients requiring chronic care management G0506 Psychotherapy for crisis 90839, 90840 Prolonged preventive services G0513, G0514 A physician, NP, PA, or CNS must furnish at least one ESRD-related “hands on visit” (not telehealth) each month to examine the beneficiary’s vascular access site. TELEHEALTH SERVICES BILLING AND PAYMENT Submit professional telehealth service claims using the appropriate CPT or HCPCS code. If you performed telehealth services “through an asynchronous telecommunications system”, add the telehealth GQ modifier with the professional service CPT or HCPCS code (for example, 99201 GQ). You are certifying the asynchronous medical file was collected and transmitted to you at the distant site from a Federal telemedicine demonstration project conducted in Alaska or Hawaii. Submit telehealth services claims, using Place of Service (POS) 02-Telehealth, to indicate you furnished the billed service as a professional telehealth service from a distant site. As of January 1, 2018, distant site practitioners billing telehealth services under the CAH Optional Payment Method II must submit institutional claims using the GT modifier. CPT only copyright 2018 American Medical Association. All rights reserved. Page 7 of 9 ICN MLN901705 March 2020 Telehealth Services MLN Booklet Bill covered telehealth services to your Medicare Administrative Contractor (MAC). They pay you the appropriate telehealth services amount under the Medicare Physician Fee Schedule (PFS). If you are located in, and you reassigned your billing rights to, a CAH and elected the Optional Payment Method II for outpatients, the CAH bills the telehealth services to the MAC. The payment is 80 percent of the Medicare PFS facility amount for the distant site service. TELEHEALTH ORIGINATING SITES BILLING AND PAYMENT HCPCS Code Q3014 describes the Medicare telehealth originating sites facility fee. Bill your MAC for the separately billable Part B originating site facility fee. Note: The originating site facility fee does not count toward the number of services used to determine payment for partial hospitalization services when a CMHC serves as an originating site. RESOURCES Telehealth Services Resources For More Information About… Resource Telehealth Services CMS.gov/Medicare/Medicare-General-Information/Telehealth/ Telehealth-Codes.html CMS.gov/Medicare/Medicare-General-Information/Telehealth CMS.gov/Regulations-and-Guidance/Guidance/Manuals/ Downloads/clm104c12.pdf Physician Bonuses CMS.gov/Medicare/Medicare-Fee-for-Service-Payment/ HPSAPSAPhysicianBonuses CMS.gov/Outreach-and-Education/Medicare-LearningNetwork-MLN/MLNProducts/MLN-Publications-Items/ CMS1246598.html Hyperlink Table Embedded Hyperlink Complete URL Health Professional Shortage Area https://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/HPSAPSAPhysicianBonuses Medicare Telehealth Payment Eligibility Analyzer https://data.hrsa.gov/tools/medicare/telehealth New Modifier for Expanding the Use of Telehealth for Individuals with Stroke https://www.cms.gov/Outreach-and-Education/MedicareLearning-Network-MLN/MLNMattersArticles/Downloads/ MM10883.pdf Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act https://www.congress.gov/bill/115th-congress/house-bill/6 Page 8 of 9 ICN MLN901705 March 2020 Telehealth Services MLN Booklet HELPFUL WEBSITES American Hospital Association Rural Health Care https://www.aha.org/advocacy/small-or-rural Critical Access Hospitals Center https://www.cms.gov/Center/Provider-Type/ Critical-Access-Hospitals-Center.html Disproportionate Share Hospitals https://www.cms.gov/Medicare/Medicare-Fee-forService-Payment/AcuteInpatientPPS/dsh.html Federally Qualified Health Centers Center https://www.cms.gov/Center/Provider-Type/ Federally-Qualified-Health-Centers-FQHCCenter.html Health Resources and Services Administration https://www.hrsa.gov Hospital Center https://www.cms.gov/Center/Provider-Type/ Hospital-Center.html Medicare Learning Network® http://go.cms.gov/MLNGenInfo National Association of Community Health Centers http://www.nachc.org National Association of Rural Health Clinics https://narhc.org National Rural Health Association https://www.ruralhealthweb.org Rural Health Clinics Center https://www.cms.gov/Center/Provider-Type/RuralHealth-Clinics-Center.html Rural Health Information Hub https://www.ruralhealthinfo.org Swing Bed Providers https://www.cms.gov/Medicare/Medicare-Fee-forService-Payment/SNFPPS/SwingBed.html Telehealth https://www.cms.gov/Medicare/MedicareGeneral-Information/Telehealth Telehealth Resource Centers https://www.telehealthresourcecenter.org U.S. Census Bureau https://www.census.gov REGIONAL OFFICE RURAL HEALTH COORDINATORS To find contact information for CMS Regional Office Rural Health Coordinators who provide technical, policy, and operational assistance on rural health issues, refer to CMS.gov/Outreach-and-Education/ Outreach/OpenDoorForums/Downloads/CMSRuralHealthCoordinators.pdf. Medicare Learning Network® Product Disclaimer The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS). Page 9 of 9 ICN MLN901705 March 2020

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