FutureFocus November 8, 2017 CMS Paying For Telehealth

Lisa Remington

In this week’s FutureFocus, we discuus the expansion of payment for telehealth under the final 2018 Physician Fee Schedule. In this week’s Washington Report are updates on regulations: PPS, HHGM and reforming regulations.

Lisa Remington, President, Remington Health Strategy Group

Starting January 1, 2018, Medicare will begin covering remote monitoring of patients with one or more chronic conditions. The new benefit, called Remote Patient Monitoring, will provide Medicare beneficiaries the choice to receive in-home monitoring in addition to traditional check-ups in clinics, doctor’s offices and hospitals. 

Buried in the 1,653-page 2018 Physician Fee Schedule rule issued on November 2, are the following codes to the list of covered telehealth services:

  • HCPCS code G0506 for chronic disease management care planning
  • HCPCS code G0296 for a visit to determine low dose computed tomography eligibility
  • CPT code 90785 for interactive complexity
  • CPT codes 96160 and 96161 for health risk assessments
  • CPT codes 90839 and 90840 for crisis psychotherapy

CMS 2018 on Telehealth

Additionally, CMS is finalizing a proposal to eliminate the required reporting of the telehealth modifier GT for professional claims in an effort to reduce administrative burden for practitioners. CMS is also finalizing separate payment for CPT code 99091, which describes certain remote patient monitoring, for CY 2018. Lastly, CMS will consider the stakeholder input we received in response to the proposed rule’s comment solicitation on how CMS could expand access to telehealth services, within the current statutory authority.

Medicare will pay for CPT code 99091 and the 2018 unadjusted reimbursement rate will be $58.67/month.

“Seniors with complex medical conditions will be benefit greatly from Medicare’s decision to cover remote patient monitoring. As we have seen, frequent medical monitoring appointments can be quite challenging, particularly for those older adults who may be frail and unable to travel long distances,” said Sabrina Smith, DrHA, American Telemedicine Association's (ATA) interim Chief Executive Officer. “ATA and its members have been strong, vocal advocates for this critical policy shift, and we are pleased to see Medicare taking this critical step forward.” 

ATA has long advocated that Medicare pay for remote patient monitoring and other tech-enabled services in the home, working with states to compile supporting evidence to ensure coverage for RPM in their Medicaid plans.

Medicare will pay for CPT code 99091 and the 2018 unadjusted reimbursement rate will be $58.67/month.