Providers looking to create or to expand telehealth offerings should take note of Medicare’s newly-published fact sheet. The fact sheet clarifies telehealth services for Calendar Year 2018 available under the Medicare Physician Fee Schedule (“MPFS”). Most notably, CMS clarified the guidelines for appropriate telehealth billing and added new codes now active for reimbursement, including:

  • G0296– Counseling visit to discuss need for lung cancer screening using low dose CT scan (service is for eligibility determination and shared decision making).
  • 90839 & 90840– Psychotherapy for crisis, first 60 minutes; and Psychotherapy for crisis, each additional 30 minutes (List separately in addition to code for primary service).

The following add-on codes were also established:

  • 90785– Interactive complexity (Listed separately in addition to the code for primary procedure).
  • 96160 & 96161– Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal), with scoring and documentation per standardized instrument; and Administration of caregiver-focused health risk assessment instrument for the benefit of the patient (e.g., depression inventory), with scoring and documentation per standardized instrument.
  • G0506– Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service).

The new Telehealth Services’ updated booklet also clarifies the conditions under which Medicare makes payments for telehealth services under the MPFS. Medicare pays a facility fee to the originating site and makes a separate payment to the distant site practitioner furnishing the service. The service must be on the list of Medicare telehealth services. The service must meet all of the following additional requirements:

  • The service must be provided via an interactive telecommunications system.
    • Exceptions exist for providers in Alaska and Hawaii.
  • The service must be provided by a physician or other authorized practitioner.
  • The service must be provided to a telehealth-eligible patient.
  • The individual receiving the service must be located at a telehealth originating site.
    • Professional Services claims must be issued with the POS 02.
    • Facility Fees for the originating site must bill the HCPCS Q3014 to the MAC.

If you need help in structuring your telehealth program for optimal effectiveness, call The Advis Group at 708-478-7030 or visit us at .

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