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.