CMS PROPOSED TELEHEALTHCHANGES TO PHYSICIAN FEE
SCHEDULE CY 2019 On July 12, 2018, the Center for Medicare and Medicaid
Services (CMS) published their CY 2019 proposedrevisions related to the Physicians Fee Schedule (PFS).Comments on the proposals are due no later than 5pm on September 10, 2018. The proposal aims tomodernize the healthcare system and help “restore thedoctor-patient relationship” by reducing administrative burden. The changes related to telehealth aresignificant, as it not only expands Medicare telehealthservices, but communicates a new interpretation byCMS of the applicability of their statutory requirementsfor reimbursement of remote communicationtechnology as separate from telehealth, and adds newservices based on this interpretation. For a moredetailed analysis of these proposals, visit CCHP'swebsite at cchpca.org.
Brief CommunicationTechnology-based
Service, e.g. VirtualCheck-in
Asynchronous RemoteEvaluation of Pre-Recorded Patient
Information
InterprofessionalInternet Consultation
Additional Proposals
When a physicianor other qualifiedhealth careprofessional has a brief non-face-to-face check-in with apatient viacommunicationtechnology to assess whether thepatient’s conditionnecessitates anoffice visit
Reimbursed at $14 Proposed code
GCVI1 Not labeled
telehealth,therefore notsubject totelehealthrestrictions
FQHC/RHCs willreceive own codefor this service
Remote professionalevaluation ofpatient-transmittedinformationconducted via pre-recorded “storeand forward” videoor imagetechnology
Proposed CodeGRAS1
Reimbursedcalculated by CMSthrough direct crosswalk to CPTcode 93793 whichin 2018 paid $12.24
Not labledtelehealth,therefore notsubject totelehealthrestrictions
FQHC/RHCs willreceive own codefor this service
Cover consultationsbetweenprofessionalsperformed viacommunicationstechnology such as telephoneor Internet
99446-99449 994X0
994X6 Value of each code
to be established Verbal consent from
patient would berequired
Add HCPCS codesG0513 and G0514 ascodes to bereimbursed iftelehealth is used.Would be subject tothe telehealthrestrictions.
Made changesrequired byBipartisan BudgetAct of 2018
For remotepyshiologicalmonitoring: codescreated andproposed to bereimbursed: 990X0,990X1 and 990X9
For chronic caremanagement: newcode forreimbursement994X7
CCHP was created in 2008 by the California Health Care Foundation, who remains its lead funder. The National Telehealth Policy Resource Center project is made possible by Grant #G22RH30365 from the Office for the
Advancement of Telehealth, Health Resources and Services Administration, DHHS. Copyrighted 2018 Center for Connected Health Policy/Public Health Institute
MANAGEMENT AND COUNSELING TREATMENT FOR SUBSTANCE USE DISORDER CMS is considering developing separate bundled payment for an episode of care for treatment of Substance UseDisorders (SUD), which can include elements of Medication Assisted Therapy (MAT), including potentially web-based routine counseling. They reason that “creating separate payment for a bundled episode of care forcomponents of MAT … under the PFS could provide opportunities to better leverage services furnished withcommunication technology while expanding access to treatment for SUDs.” It could also help alleviate the need formore acute services and prevent hospital readmissions.
