Medicare Telehealth Fact Sheet

Over the past few weeks, there has been sweeping changes in response to the COVID19 pandemic. 

It can be very confusing to assimilate all of the information by both Medicare and commercial insurance companies. Given the current climate of social distancing, people want to access healthcare in a manner that is safe and responsible.

Here is some information distilled from the CMS website regarding medicare coverage and payment of virtual visits or commonly known as telehealth.

Under President Trump’s leadership, CMS has expanded and broadened access of telehealth services to its beneficiaries. This is a direct result of the COVID19 pandemic in order to decrease the spread of this virus and help people access healthcare from their home.

Telehealth, in general, refers to the use of electronic communications from one site to another to improve a patient’s health.  Beginning March 6th of 2020, Medicare will pay for beneficiaries to access healthcare from their home. Providers eligible for reimbursement of these services include physicians, nurse practitioners, clinical psychologists and clinical social workers. As of this time, licensed clinical therapists are not eligible for reimbursement (from medicare). Please keep in mind that the rules for medicaid (which is administered, in part, by individual states) may have different rules regarding reimbursement of licensed clinical therapists.

These visits are considered to be the same as in person visits and, therefore, will be reimbursed at the same rate as in person visits. Medicare coinsurance and deductibles would generally apply to these services. However, the Office of Inspector General (OIG) is allowing healthcare providers to reduce or waive these cost sharing portions for telehealth if these visits are paid for by federal healthcare programs.

The three main types of virtual services Medicare allow are telehealth visit, virtual check ins, and e-visits. Telehealth visits are conducted over the phone or with video conferencing technology and occurs in real time. Virtual check ins are initiated by the patient and are brief communications. These are only available to patients that have an existing relationship with the provider (not for new patients). And E-visits are non face to face communications initiated by patients through an online patient portal.

Therapists will generally only provide telehealth to their patients. Telehealth will use the same CPT codes as in person therapy. The most common CPT codes are as follows:

90791 Diagnostic evaluation

90837 Psychotherapy, 60 minutes with patient

90834 Psychotherapy, 45 minutes with patient

90832 Psychotherapy, 30 minutes with patient

Other changes for claims submission in providing telehealth include the place of service. Typically, place of service has been in the office (11). When using telehealth, the place of service is the patient's home (02).

The other change has been the use of modifiers. Although CMS officially retired the GT modifier (and was replaced with modifier 95) earlier this year, not all of the Managed Care Administrators (MAC) have updated their computer systems to be able to accept it. For example, National Government Services, Inc. does not recognize the 02 place of service and requires the 11 as the place of service with the 95 modifier to indicate telehealth.

Always check with your MAC to determine how they want the claims forms coded for telehealth. 

HIPAA has also been expanded to help people access care more readily. Given most providers were not set up for telehealth at the time of this pandemic, changes that allow clinicians to quickly offer these services have been made. 

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA):  “Effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.”  For more information: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

Key takeaways are:

Medicare will reimburse for telehealth at the same rate as for in person services.

There will be some HIPAA waivers if the provider serves patients in good faith through accessible technologies such as facetime or skype.

I believe everyone is doing their best to adjust to these changes as a result of COVID19. I know it can be stressful when psychotherapists are being forced to change the way they provide services to their patients, as well as, their business practices. Let's offer a little grace to each other and to ourselves.

As a Psychologist with a thriving business, I believe that owning an insurance based private practice is the key to financial freedom, professional freedom, and personal freedom. If you have questions or need help creating your own practice, contact me at Robin@DrRobinMyers.com. I offer Coaching and Consulting Services.