December 11, 2019

December 11, 2019

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December 10, 2019

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December 09, 2019

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Telehealth: Medicare Finalizes New Services for 2020 in Physician Fee Schedule

CMS just released the 2020 final rule with changes to its virtual care codes. The new provision, officially titled “Communication Technology-Based Services,” introduces three new covered Telehealth Services. These changes were proposed as part of the 2020 Physician Fee Schedule earlier this year and continue CMS’ efforts to reduce administrative burden and cover more virtual care services in the Medicare program

Consent for Communication Technology-Based Services (CTBS)

In an effort to alleviate administrative burdens, CMS will allow practitioners to obtain a single consent from the patient, covering multiple CTBS services or interprofessional consultation services. The single consent must now be obtained at least once per year, as opposed to the previous requirement of once per service, which is welcome news to industry members. The consent must also include the amount of the patient’s financial responsibility (e.g., co-pay).

New Telehealth Services

Starting January 1, 2020, the following three codes (describing new bundled services for treatment of opioid use disorders) will be available as part of the covered Medicare telehealth services list:

  1. HCPCS code G2086: Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month.

  2. HCPCS code G2087: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month.

  3. HCPCS code G2088: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (List separately in addition to code for primary procedure).

CMS explained that, like certain other non- face-to-face services, the other components of HCPCS codes G2086-G2088 describing care coordination are commonly furnished remotely using telecommunications technology, and do not require the patient to be present in-person with the practitioner when they are furnished. CMS also stated that by considering the face-to-face portion of HCPCS codes G2086-G2088 eligible for telehealth services, the originating site facility fee could be reported, consistent with all other rules, when these services are furnished via telehealth.

With respect to the originating site requirements, recall that, the SUPPORT Act, effective as of July 1, 2019, statutorily removed the geographic limitations for telehealth services furnished to individuals diagnosed with a substance use disorder (SUD) for the purpose of treating the SUD or a co-occurring mental health disorder. The change allows telehealth services for treatment of a diagnosed SUD or co-occurring mental health disorder to be furnished to individuals at any telehealth originating site (other than a renal dialysis facility), including in a patient’s home. No originating site facility fee is paid when the beneficiary’s home is the originating site.

How to Request Additional Medicare Telehealth Services

There is a specific process to request additions or deletions from the list of covered telehealth services. Initially, CMS assigns each proposed code to one of two categories. Category 1 is for those services similar to professional consultations, office visits, and office psychiatry services currently on the list of telehealth services. Category 2 is for those services not similar to those on the current list of telehealth services. Proposals that fall into Category 2 undergo a more exacting review, including whether the proposed service will produce demonstrated clinical benefit for patients. When submitting a proposal to request coverage of a new service/code, the proposer should be sure to identify the category to which the service will be assigned, so as to determine the type of clinical and non-clinical supporting documentation that CMS will expect to accompany the submission.

Interested parties need not wait on Congress or CMS to act; anyone may send CMS a request to add existing services (HCPCS codes) to the list of covered Medicare telehealth services. This can include medical specialty societies, individual physicians or practitioners, entrepreneurs, hospitals, state and federal agencies, telehealth companies, vendors, and even patients. Requests may be submitted at any time on an ongoing basis. The requests will be consolidated and considered during the CMS rulemaking cycle.

Instructions for submitting requests can be found on the CMS Telehealth website. Specifically, each request should address the following:

  • Name(s), address, and contact information of the requestor.

  • The HCPCS code(s) that describes the service(s) proposed for addition or deletion to the list of Medicare telehealth services. If the requestor does not know the applicable HCPCS code, the request should include a description of services furnished during the telehealth session.

  • A description of the type(s) of medical professional(s) providing the telehealth service at the distant site.

  • A detailed discussion of the reasons the proposed service should be added to the definition of Medicare telehealth service.

  • An explanation as to why the requested service cannot be billed under the current scope of telehealth services, for example, the reason why the HCPCS codes currently on the list of Medicare telehealth services would not be appropriate for billing the service requested.

  • Evidence that supports adding the service(s) to the list on either a Category 1 or Category 2 basis as explained in the section on the CMS webpage labeled “CMS Criteria for Submitted Requests.”

Email your request to Telehealth_Review_Process@cms.hhs.gov and title it “Telehealth Review Process.” Alternatively, you can mail the request to: Division of Practitioner Services, Mail Stop: C4-03-06, Centers for Medicare and Medicaid Services, 7500 Security Boulevard Baltimore, Maryland 21244-1850. Attention: Telehealth Review Process.

The deadline for 2021 PFS consideration is now through February 10, 2020.

© 2019 Foley & Lardner LLP

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About this Author

Nathaniel Lacktman, Health Care Attorney, Foley and Lardner Law Firm
Partner

Nathaniel (Nate) Lacktman is a partner and health care lawyer with Foley & Lardner LLP, and a Certified Compliance & Ethics Professional (CCEP). His practice focuses on health care compliance, counseling, enforcement and litigation, as well as telemedicine and telehealth. Mr. Lacktman is a member of the firm’s Health Care Industry Team which was named “Law Firm of the Year — Health Care Law” for three of the past four years on the U.S. News – Best Lawyers® “Best Law Firms” list. 

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Emily Wein Health Care Lawyer
Of Counsel

Emily H. Wein is of counsel and a health care lawyer with Foley & Lardner LLP, and member of the firm’s national Telemedicine & Digital Health Industry Team. Emily understands and identifies with the business and strategic goals of virtual care and digital health companies. She delivers practical legal guidance molded to accomplish each individual client’s unique operational goals. Emily works with a diverse bench of organizations – including large interdisciplinary hospital systems, skilled nursing facilities, multi-state clinical practices, and fast-moving entrepreneurs. Emily’s energy and enthusiasm mirrors that of her health innovation clients where she consistently drives to improve some of the most important and unmet health needs in the industry today, particularly women’s health, substance use disorder, mental health, and preventative wellness.

Emily wields notable depth on advising telemedicine and digital health clients on the highly technical, traditional healthcare regulatory issues of Medicare and Medicaid enrollment, billing and coding, interjurisdictional claims submission and reassignment, compliance with Conditions of Participation, and medical staff credentialing and privileging.

Real-World Industry Knowledge

Having earned both a law degree and an MBA, Emily understands the importance of practical business perspectives while maintaining that sense of urgency essential to the success of any innovative health technology offering. Whether an emerging start-up entrepreneur with a novel or breakthrough idea or an established health system with many constituents to align, Emily works efficiently and effectively to meet the distinctive requirements of each organization. Additionally, she spent five years as in-house counsel at a nationally-known academic medical center health system, where she led the development of its virtual care service programs, including tele-stroke and tele-cardiology, and had primary legal responsibility for fraud and abuse compliance of all Medicare enrollment and physician-hospital contracting arrangements.

Thought Leadership

  • Original member of the Clear Health Quality Institute’s Telehealth Accreditation Standards Committee, where she helped develop the standards and requirements for telehealth companies seeking CHQI accreditation.

  • Helped create the Maryland Telehealth Alliance; a mission-driven organization to advance telehealth law in the State of Maryland. She serves as its Chief Legal Officer.

  • Serves on the Advisory Board of Nest Collaborative, a telehealth provider specializing in women’s and pediatric services.

  • Co-authored The Telehealth Law Handbook: A Practical Guide to Virtual Care.

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