CMS Finalizes Reimbursement for New Virtual Services

November 21, 2018 | Eric D. Fader | Legislation and Public Policy | Medicare and Medicaid | Telehealth

The final 2019 Medicare Physician Fee Schedule released on November 1, 2018 by the Centers for Medicare & Medicaid Services (CMS) includes a section entitled “Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services.” Effective January 1, 2019, physicians may be reimbursed for certain virtual interactions with patients using several new billing codes.

One new code will allow physicians and other providers to be reimbursed for “brief communication technology-based services,” often called “virtual check-in” appointments. Modeled after an existing billing code that provides for billing of 5-10 minutes of medical discussion by telephone, the new code will cover brief medical discussions using other communication modalities. According to CMS, the new code will “mitigate the need for potentially unnecessary office visits.” Medicare will pay $14 per visit for virtual check-ins.

Another new code will permit asynchronous telemedicine, or “store & forward” medical care, to be reimbursable without the use of interactive audio/video or a face-to-face exam. The new code covers a healthcare provider’s review of “recorded video and/or images captured by a patient in order to evaluate the patient’s condition” in order to determine whether an office visit is necessary. This code will allow a dermatologist, for example, to remotely analyze a photograph of a skin condition.

Yet another new code will cover reimbursement for peer-to-peer internet or telephone consultations, such as when the patient’s treating physician requests the advice of a specialist without the patient having face-to-face contact with the latter. In addition, telehealth services that are already covered by Medicare will be expanded to include prolonged preventive services.

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