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April 8, 2020

AGA continues push for payment parity for telephone E/M visits

CMS acknowledges the problem. AGA is working on multiple fronts for resolution.
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Last week, we were disappointed with Medicare’s decision to limit providers that treat Medicare beneficiaries via telephone to only use telephone evaluation and management (E/M) codes (99441-99443), which pay between $15 and $39 nationally, instead of using E/M codes (e.g., 99201-99205, 99211-99215) with a telehealth modifier. These new rules were included in the agency’s recently released interim final rule.

Here is an update on AGA’s efforts to address the telephone E/M coverage and payment parity:

  • CMS is looking for a solution: On a COVID-19 public forum call, AGA staff asked CMS what actions the agency plans to take to allow audio-only telephone communication to be reported and paid as telehealth using E/M codes (99201-99205, 99211-99215). CMS staff acknowledged the problem and announced it is looking into solutions.
  • AGA joined ACP in asking CMS for payment parity: Last week, we collaborated with ACP to press CMS for payment parity for telephone E/M visits. Earlier this week, ACP led a sign-on letter to CMS on this issue, which AGA signed.
  • Two major commercial payers allow telephone E/M visits to be reported and paid as telehealth: United joined Humana this week in allowing audio-only communication to be coded and paid as telehealth during the public health emergency (PHE). See AGA’s updated commercial payer guide to telehealth.
  • Select states allow telephone E/M visits to be reported and paid as telehealth: To date, New York, Texas, Vermont, Maine (for MaineCare) and Missouri (for HealthNet) allow providers to report telephone (audio-only) services as telehealth as per the Center for Connected Health Policy COVID-19 State Action Guide. Be sure to read your state’s policy carefully before acting. Please note that this does not apply to traditional Medicare.

AGA will continue to advocate for payment parity for telephone E/M visits during this PHE. For more information, visit AGA’s COVID-19 updates page and join the discussion in the AGA Community.

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