Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
2008
2009
2010
Announcements
Articles
Articles and Publications
Campaign
Case Studies
Charge Capture and Pricing
Coding Integrity
Company
Consulting
Craneware Insights Articles
Education
Home
Journey
News & Events
Opportunities
Other
post
Press Releases
Products
Services
Testimonial
Trade Shows
Uncategorized
Uncategorized
Upcoming Events
Value Cycle
Webinars
White Papers

REVISION – Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)

Craneware® Insights Regulatory Updates – CWI1215 (25 March 2020)


Topic

REVISION – Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)

On March 20, 2020, CMS released a revised MLN Matters® Special Edition Article, number SE20011, in which information is provided regarding blanket waivers issued under a declared public health emergency (PHE) that affect Medicare Fee-for-Service (FFS) providers.

Provider Types Affected

Critical Access Hospitals
OPPS Hospitals
Provider-Based FQHC
Provider-Based Rural Health Clinics
Physicians

Departments/Areas Affected

Business Office
Compliance / Revenue Integrity
Electrophysiology Lab
Finance
HIM/Medical Records
Telemedicine

What You Need to Know

On March 16, 2020, CMS released MLN Matters® Special Edition Article, number SE20011, in which information is provided regarding blanket waivers issued under a declared public health emergency (PHE) that affect Medicare Fee-for-Service (FFS providers. Please access Craneware Insights article #1211 for a summary of information contained in SE20011.

CMS has revised this article on multiple dates. The original article was revised on March 18, 2020 to add a section on telehealth services. The revision states that Medicare will pay for office, hospital, and other visits furnished via telehealth across the country and including in a patient’s residence starting March 6, 2020. The range of personnel that may offer telehealth services include providers such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers.

There are three types of virtual services that may be provided to Medicare beneficiaries:

  • Medicare telehealth visits;
  • Virtual check-ins; and
  • e-visits.

Medicare provided the following table to summarize telemedicine services:

Type of Service

Description of Service

HCPCS/CPT® Code

Patient Relationship with Provider

Medicare Telehealth Visits

A visit with a provider that uses telecommunication systems between a provider and a patient.

Common telehealth services include:

  • 99201-99215 (Office or other outpatient visits)
  • G0425-G0427 (Telehealth consultations, emergency department or initial inpatient)
  • G0406-G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs)

For a complete list:

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

For new* or established patients.

*To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.

Virtual Check-in

A brief (5-10 minutes) check in with your practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.

  • G2012 (Brief communication technology-based service…)
  • G2010 (Remote evaluation of recorded video and/or images submitted by an established patient)

For established patients

E-Visits

A communication between a patient and their provider through an online patient portal

  • 99421 (Online digital E/M Svc, 5-10 min)
  • 99422 (Online digital E/M Svc, 11-20 min)
  • 99423 (Online digital E/M Svc, 21+ min)
  • G2061 (Qualified nonphysician online assessment, est. patient, 5-10 min)
  • G2062 (Qualified nonphysician online assessment, est. patient, 11-20 min)
  • G2063 (Qualified nonphysician online assessment, est. patient, 21+  min)

For established patients

Please note that the above information on telehealth services was also provided in a CMS news article in which they announced the “expansion” of telehealth as well as issuing a “Telemedicine Health Care Fact Sheet” and a “Medicare Telehealth Frequently Asked Questions (FAQs)” document. We are providing the links to these documents under the “Background” section of this article. Craneware also published an Insights article, #1212, entitled “COVID-19 – Telehealth Expansion”.

The March 20, 2020 revision to SE20011 partially rescinds the previously issued directive concerning the “DR” condition code and the “CR” modifier, which are to be used for claims to receive Medicare payment based on a “formal waiver” under Section 1135 of the Social Security Act.  The revised article explicitly states that the “DR” condition code and the “CR” modifier are NOT required for telehealth claims for which Medicare payment is based on a “formal waiver”. However, Medicare reminds providers that there are three scenarios in which modifiers are required for Medicare telehealth services:

  1. GQ modifier: Required when telehealth services are furnished via asynchronous (store and forward) technology as part of a federal telemedicine demonstration project in Alaska and Hawaii;
  2. GT modifier: Required when telehealth services are billed under Critical Access Hospital (CAH) Method II; and
  3. G0 modifier: Required when telehealth services are furnished for the purpose of diagnosis and treatment of an acute stroke.

Action Needed

Facilities and providers should read the revised MLN Matters article and the associated telehealth documents in their entirety. Inform staff responsible for billing telehealth services that the previously issued directive on the “DR” condition code and the “CR” modifier do NOT apply to telehealth services.

Effective Date

01 March 2020

Background

Telemedicine Health Care Fact Sheet:

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

Medicare Telehealth Frequently Asked Questions (FAQs), March 17, 2020:

https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

Section 1135 of the Social Security Act:

Reference

https://www.cms.gov/files/document/se20011.pdf

CPT Codes © 2020 American Medical Association, use of this site denotes acceptance of below terms and conditions

CPT codes, descriptions, and material only are copyright 2020 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained here in. CPT is a trademark of the American Medical Association.

The responsibility for the content of any ‘National Correct Coding Policy’ included in this product is with Centers for Medicare and Medicaid Services, formerly known as Health Care Financing Administration, and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

Applicable FARS/DFARS Restrictions Apply to Government Use.

Current Dental Terminology copyright © 2020 American Dental Association. All rights reserved.

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipient(s) and not to be shared with other facilities or vendors outside of Craneware. Craneware Inc, 3340 Peachtree Road, N.E., Suite 850, Atlanta, GA 30326, Tel: 404-364-2032 email: info@craneware.com