telehealth CPTThe Centers for Medicare and Medicaid Services (CMS) is preparing to eliminate the majority (74) of the temporary telehealth CPT codes created during the pandemic once the public health emergency (PHE) ends. It is, however, adding 13 new codes, and keeping 9 codes added during the COVID-19 emergency.

The 13 new codes to be added are placed in a new category, Category 3. Category 1 CPT codes will remain, but Category 2 CPT codes are scheduled for elimination at the end of the PHE. The new Category 3 CPT codes will stay in force through the end of the PHE, and are an effort by CMS to expand telehealth coverage, while it looks for evidence to support them. CMS believes these codes could be added on a permanent basis, but require more use and feedback from stakeholders before they can make a final determination.

CMS Looking for Evidence to Support Telehealth CPT Codes

The public has an opportunity to provide feedback and submit requests to CMS to add some of these Category 3 telehealth CPT codes to Medicare telehealth services permanently. CMS is looking for the public to provide relevant clinical studies that show that the service delivered by telehealth improves diagnosis, treatment or improves the functioning of a malformed body part. CMS is soliciting published, peer-reviewed articles regarding the same as well.

Who’s in Charge of Telehealth CPT Codes: CMS, Executive Order, Congress or All?

President Trump’s executive order, (see President Issues Executive Order on Improving Rural Health and Telehealth Access) which has a 60-day limit, requires the Department of Health and Human Services Secretary to propose a regulation to extend some or all of CMS’s emergency telehealth measures including telehealth CPT codes “as appropriate during the duration” of the public health emergency. Further, Congress has the ability to make more dramatic changes to coverage and telehealth billing codes, but due to the current political environment and the extraordinary number of proposed bills addressing telehealth, (see Telehealth Act HR 7992 Telehealth Legislation Combines Nine Separate Bills) it’s difficult to predict an outcome with any sense of certainty. Some changes may be included in the next stimulus bill and others may be separate legislation.