What You Need to Know About the New CMS 2021 Telehealth Services Plans
The Centers for Medicare & Medicaid Services (CMS) finally came out with its plans to expand telehealth coverage once the COVID-19 pandemic is over.
The 2021 Physician Fee Schedule, which was released earlier this month, highlighted several new opportunities for remote patient monitoring and added nine billing codes for connected health services. However, 74 codes are slated to end when the public health emergency is over. While some vocal detractors have said the changes don’t go far enough, many proponents say the proposed changes would offer providers a coherent and permanent path forward from the emergency measures initiated in March to deal with COVID-19.
These plans came, incidentally or intentionally, on the same day that President Trump issued an executive order focused on “Improving Rural Health and Telehealth Access,” which included a number of important telehealth policy proposals, including an expansion of the list of telehealth services that will remain permanent beyond the COVID-19 public health emergency. It also proposed Category I and Category III codes, some of which will remain on the list through the calendar year in which the public health emergency (PHE) ends.
“Compared to last year, where CMS made only minor additions to telehealth services, the changes proposed for 2021 are bold and designed to more deliberately expand the use of telehealth technologies among Medicare beneficiaries” Nathaniel Lacktman, a partner with Foley & Lardner and chair of its Telemedicine & Digital Health Team, said in a blog co-authored by Thomas Ferrante, senior counsel, and Emily Wein, an attorney with the firm.
Telehealth Services Expected to Become Permanent
CMS proposed adding nine codes to the list of telehealth services covered under Medicare, to remain covered even after the PHE ends. Subject to CMS’ final rule, these services are expected to be added, on a permanent basis, effective January 1, 2021.
Service Type |
HCPCS/CPT Codes |
|---|---|
|
Group Psychotherapy |
90853 |
| Domiciliary, Rest Home, or Custodial Care services, Established patients | 99334-99335 |
| Home Visits, Established Patient | 99347- 99348 |
| Cognitive Assessment and Care Planning Services | 99483 |
| Visit Complexity Inherent to Certain Office/Outpatient E/Ms | GPC1X |
| Prolonged Services | 99XXX |
| Psychological and Neuropsychological Testing | 96121 |
Telehealth Services Expected for Removal When the PHE Expires
CMS proposed removing seventy-four (74) codes when the PHE expires. This, CMS says, is due to its conclusion that there would be no likelihood of clinical benefit after the PHE ends. Stakeholders can submit comments and clinical data in support of making one or more of these codes permanent.
Service Type |
HCPCS/CPT Codes |
|---|---|
| Initial nursing facility visits, all levels (Low, Moderate, and High Complexity) | 99304-99306 |
| Psychological and Neuropsychological Testing | 96136-96139 |
| Therapy Services, Physical and Occupational Therapy, all levels | 97161-97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507 |
| Initial hospital care and hospital discharge day management | 99221-99223, 99238- 99239 |
| Inpatient Neonatal and Pediatric Critical Care, Initial and Subsequent | 99468- 99472, 99475- 99476 |
| Initial and Continuing Neonatal Intensive Care Services | 99477-99480 |
| Critical Care Services | 99291-99292 |
| End-Stage Renal Disease Monthly Capitation Payment codes | 90952-90953, 90956, 90959, 90962 |
| Radiation Treatment Management Services | 77427 |
| Emergency Department Visits, Levels 4-5 | 99284-99285 |
| Domiciliary, Rest Home, or Custodial Care services, New | 99324-99328 |
| Home Visits, New Patient, all levels | 99341- 99345 |
| Initial and Subsequent Observation and Observation Discharge Day Management | 99217-99220, 99224- 99226, 99234-99236 |
New Telehealth Services During PHE (Category 3 Codes)
CMS created a new category of codes designed for adding new Medicare-covered telehealth services, but on a temporary basis. Codes added this way would remain covered through the end of the year in which the PHE expires. For example, if the PHE expires in March 2021, these codes will remain Medicare-covered telehealth services until December 31, 2021.
For a Category 3 service to become permanent, stakeholders will need to submit to CMS:
- A description of relevant clinical studies that demonstrate the service, when furnished via telehealth, improves the diagnosis or treatment of an illness or injury, or improves the functioning of a malformed body part (including dates and findings of those studies)
- A list and copies of published peer-reviewed articles relevant to the service when furnished via telehealth.
CMS proposed adding the thirteen (13) codes below to the Category 3 list:
Service Type |
HCPCS/CPT Codes |
|---|---|
| Domiciliary, Rest Home, or Custodial Care services, Established patients | 99336-99337 |
| Home Visits, Established Patient | 99349-99350 |
| Emergency Department Visits, Levels 1-3 | 99281-99283 |
| Nursing facilities discharge day management | 99315-99316 |
| Psychological and Neuropsychological Testing | 96130- 96133 |
How to submit comments to CMS
Providers, technology companies, entrepreneurs, and advocates interested in telemedicine and digital health should consider submitting comments to the proposed rule anonymously or otherwise via electronic submission at this link. Alternatively, commenters may submit comments by mail to:
- Regular Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1734-P, P.O. Box 8016, Baltimore, MD 21244-8016.
- Express Overnight Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1734-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850 (for express overnight mail).