Sunday, November 7, 2010

Telehealth Coverage Increased

CMS has finalized all of their proposed code additions pertaining to telehealth coverage for 2011 with changes going into effect January 1, 2011. The final rulemaking released on November 2, 2010 and due to be published in the Federal Register on November 29, 2010, presents the finalized CMS proposals relating to telehealth.

Proposed code additions for Telehealth payments will include:

• Individual and group Kidney Disease Education (KDE) services (HCPCS codes G04 and G0421) respectively
• Individual and group Diabetes Self-Management Training (DSMT) services with a minimum of one hour of in-person instruction to be furnished in the year following the initial DSMT service to ensure effective injection training (HCPCS codes G0108 and G0109) respectively
• Group Medical Nutrition Therapy (MNT) and Health and Behavior Assessment and Intervention (HBAI) services (CPT codes 97804 and 96153 and 96154) respectively
• Subsequent hospital care services with the limitation for the patient’s admitting practitioner of one telehealth visit every 3 days (CPT codes 99307, 99308, 99309, and 99310)
• Subsequent nursing facility care services with the limitation for the patient’s admitting practitioner of one telehealth visit every 30 days (CPT codes 99307, 99308, 99309, and 99310)

Also, CMS is adding individual and group KDE and DSMT, services, group MNT services, group HBAI services, and subsequent hospital care and nursing facility care services to the list of telehealth services for which payment will be made at the applicable PFS payment amount for practitioner services.

In addition, CMS has reordered the listing of services removed with initial and follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals and Skilled Nursing Facilities (SNF) in 410.78(b) because these are described by the more general term “professional consultation” included in the same section. Finally, CMS is continuing to specify that the physician visits required under 483.40(c) may not be furnished as telehealth services.

Originally, the payment amount for the Medicare telehealth originating site facility fee for telehealth services provided from October 1, 2001 through December 31, 2002 was set at $20 for telehealth services but now the fee is set at $24.10.

Go to to see the final rulemaking and go to pages 486-526 to read the major section on telehealth.