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New CPT Codes Approved for Telehealth

New CPT Codes Approved for Telehealth

In Medicare’s 2014 physician fee schedule, the Centers for Medicare and Medicaid Services outlined several new telehealth services and service regions that will be reimbursed by the federal government starting 2014.  These changes include new services for mental health providers.

CMS is expanding the geographic areas where Medicare will cover telehealth into the “the fringes of metropolitan areas,” as noted by the American Telemedicine Association (ATA).

New CPT Codes & Other Supportive Changes

According to the ATA, other substantial changes that further support telehealth include:

* Adding coverage for transitional care management services (CPT codes 99495 and 99496) and making explicit that coverage includes the Evaluation and Management portion of these services;

* Adding coverage for chronic care services (CPT codes 99487-99489) for patients with multiple chronic conditions that are expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.  These services are for a patient whose medical and/or psychosocial problems require moderate or high complexity medical decision-making during transitions in care from an inpatient hospital setting. 

Facility Fees Increase

Medicare also provides payment of a facility fee to approved originating sites.  That telehealth originating site facility fee for 2014 is increased to $24.63—up 20 cents from 2013.

Use Modifer Codes

Add modifier “GT “Interactive audio and video telecommunications systems or “GQ” Asynchronous telecommunications system to the procedure codes when billing to indicate the use of telecommunications  services.

Adding new CPT Codes

Every year, CMS solicits requests to add services to the list of Medicare telehealth services. The deadline to submit requests  is December 31 for the next rulemaking cycle. For instructions, visit www.cms.gov/telehealth.

New Website Being Built by HRSA to Aid Providers

The complexities of knowing whether or not providers are eligible for reimbursement will soon be reduced with a new website currently being built by the Health Resources Services Administration (HRSA).

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