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August 25, 2020

What You Need to Know About the New CMS 2021 Telehealth Services Plans

Matt McBride
CEO, Mend

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 patients99334-99335 
Home Visits, Established Patient 99347- 99348 
Cognitive Assessment and Care Planning Services 99483 
Visit Complexity Inherent to Certain Office/Outpatient E/Ms GPC1X 
Prolonged Services99XXX 
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: 

  1. 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)
  2. 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).

Written by

Matt McBride
CEO, Mend

Matt and 3 best friends founded Mend in 2014 to help reimagine patient and provider experiences. Mend is one of the fastest growing companies in the U.S. with a #1 rated telemedicine software platform. Mend also offers a complete patient engagement solution that seamlessly spans both virtual and in-person appointments creating a complete patient communication solution for health organizations.

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