Medicare reimbursement

Apparently CMS has improved access for medicare patients to telehealth services. I’ve been seeing conflicting information about mental health. Previously psychotherapy was covered only in select rural regions. Does anyone know if the rule has been relaxed and if so, what the new rules are?

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Hi Dr. Levenstein, thank you for posting this question!

Would something like this Billing Guide for Telehealth Encounters be useful?

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It looks like, from that document and the Medicare web site, that they Medicare has not removed the geographic restrictions for office to home psychotherapy treatment. You still have to be in an extremely rural area to do this. Has anyone seen anything different?

There has been no change that I know of. Because of what is happening right now with this Covid19,more and more clients will want to do teletherapy. NOW is the time to contact your congressman! Call and follow up with an email.
Tricare pays for online therapy as if it were an office session. There is no difference in billing. They announced it almost 3 years ago, and I confirmed it with Humana via email. No other insurance in NC pays this way. I have already contacted Senator Burr’s office. They thanked me for bringing this to their attention. I am hoping that many other therapists do the same! Timing is important, and I think NOW, many legislators will be receptive to making changes with Fed, State and possibly private insurance.

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I have also emailed my senator. No response yet. I agree that we all need to press our representatives and senators on this issue.

Looks like Medicare is now reimbursing for telehealth visits for all beneficiaries. Here’s the fact sheet with the HCPCS and CPT codes. Providers can finally get paid for these consultations even if the patient doesn’t meet the previous “rural areas” guidelines. https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf

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It looks to me like they are now covering ONLY patients with Medicare Advantage plans that themselves cover telehealth. This is the paragraph that covers it:

Medicare Advantage plans may provide their enrollees with access to Medicare Part B services via telehealth in any geographic area and from a variety of places, including beneficiaries’ homes. With this flexibility, it is possible that beneficiaries in Medicare Advantage plans can receive clinically appropriate services for treatment of COVID-19 via telehealth.

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APA is working on this. Currently Medicare only reimburses in rural areas, and they define “rural” not us.

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This was sent to me by a colleague of ours. He said he would write up a blog post about this topic but sharing here first in the event it helps clarifiy issues:

Medicare Part B is covering telehealth visits with established patients who have been seen by the practice in the last 3 years. They’ll need to use the following CPT codes depending on the length of visit with combined with the following Place of Service Code:

CPT Codes: 99421 (5-10 minutes); 99422 (11-20 minutes) ; 99423 (21 or more minutes) - these are physician only codes, non-physician codes are HCPCS: G2061-G2063

POS Code: 02 Telehealth

https://www.jdsupra.com/legalnews/congress-expands-medicare-telehealth-55541/

https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set

https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf

https://homehealthcarenews.com/2020/03/coronavirus-scare-likely-to-boost-telehealth-adoption-among-home-based-care-providers/

https://www.alston.com/-/media/files/insights/publications/2020/03/coronavirus-emergency-funding.pdf

https://homehealthcarenews.com/2020/03/cms-humana-call-attention-to-telehealth-lifeline-amid-coronavirus-outbreak/

https://www.aafp.org/journals/fpm/blogs/gettingpaid/entry/coronavirus_testing_telehealth.html

https://mhealthintelligence.com/news/breaking-telehealth-coverage-included-in-coronavirus-spending-bill

LCD Contact info by state -

https://www.cms.gov/Medicare/Coverage/DeterminationProcess/LCDs

Again, this is only for DR.s This is not TeleMental Health for LCSW’s or Psychologists. I am still hoping that MEDICARE will change this soon… Many beneficiaries who are older are not going to want to leave their house to go see their therapist and anxiety and depression are likely to increase, especially during these times.

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Hi are these links helpful?

To close this topic out, AP and most of the other major news sites are reporting today that Medicare has dropped its limitations on telehealth and is now in line with other health insurers. This is only temporary, however, and after the crisis is over, they may revert back to their previous limitations. I would expect that they won’t go back after they find that this system works fine, but don’t bet your license on it.

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Does anyone know if general insurance/ Medicare is reimbursing for Physical Therapy service through a video/audio platform?

See below for updates related to reimbursement during COVID-19 pandemic.
Telehealth Reimbursement FAQ’s.docx (456.8 KB)

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@drlevenstein just wanted to give you a shout out of thanx for instilling confidence that you were reading the details of the policies as they were evolving over the past month and sharing them here. :facepunch:

@JimC thanx for that document! Spot on! :trophy: