Telehealth and Newly Approved CPT Codes

November 30, 2013 | Health Services

Medicare’s 2014 Physician Fee Schedule includes several new Telehealth services and service regions that will be reimbursed under the Medicare Program beginning in 2014. 

The new Fee Schedule will expand the geographic areas Medicare will cover Telehealth, expanding into the “fringes of metropolitan areas.”  The American Telemedicine Association has stated this will enable providers to be reimbursed under the Telehealth program. The new Fee Schedule expands coverage by adding transitional care management services (CPT Codes 99495 and 99496) and making clear that coverage includes the E&M (Evaluation and Management) portion of these services.  Coverage has also been added for chronic care services (CPT Codes 99487 through 99489) for those patients with multiple chronic conditions that are expected to exist for at least twelve months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline.  These specific services are geared for patients whose medical and/or psychosocial problems require moderate or high complexity medical decision-making during transitions in care from an in-patient hospital setting.  Facility fees have been increased and Medicare provides payment of a facility fee to approved originating sites.  The Telehealth originating site facility fee for 2014 is now $24.63, up twenty cents from 2013.  The modifier “GT” is appropriate for procedure codes when billing to indicate the use of telecommunications services.  Every year, CMS solicits and considers adding services to the list of Medicare Telehealth services.  Submissions of requests are due December 31st each year and for instructions on submission of proposed Telehealth services, visit

Providing services over a secure communications vehicle is a benefit to the patient and the provider.  The patient has to own or have access to telecommunication devices enabling the patient to see and listen to their provider over a secure line.  The provider from his or her office can evaluate and consult with the patient without having to travel outside his or her office.  The number of patients that may be seen and evaluated and monitored is thereby increased based upon the ease of access via these telecommunication devices.  Especially in areas where mental health providers are few and far between, patients should not be denied access to these services based upon geography.  Telemental health services enable continuity of care between patients who need frequent evaluation and management and their providers who are able to evaluate them from their own office. 

Additional articles on this topic will appear in future releases so be sure to read future news articles from Rivkin Radler.  Should you have any questions or need any assistance on this topic or others involving health care related law, please contact the author.


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