2020 – New Telehealth Codes and Changes to Rpm Services in the Final Rule

Telehealth is adding new venues of care and is the future of healthcare. According to a study by Global Market Insights, the global market of Telehealth will expand to $130.5 billion by 2025. Telehealth has opened new opportunities in the healthcare arena and is considered especially useful for the residents of rural areas who would be getting healthcare services remotely due to it. To grab this opportunity, healthcare services providers are taking interest in several new technologies that can help them in remote patient monitoring through audio, video and digital photography.

Remote health monitoring is already in use for the past several years and consumers are taking more interest in wearable tech and smartphone apps that can remotely transmit vitals and other health information of the patients to healthcare facilities. Telehealth technologies are giving more liberty to patients who can now manage their health from the comfort of their homes by using remote health technologies.    

In this perspective, the Centers for Medicare & Medicaid Services (CMS) have made several changes this year to accommodate Telehealth services. Telehealth services would include physician consultation, psychotherapy and several other services that eligible providers would be provided to patients remotely by using interactive communication technologies. Patients now can avail of certain Telehealth services, including diagnosis, evaluation, and treatment, from their home. To offer these services, a provider must be present at a practice office, hospital, rural health clinic or a nursing center.

Several new codes were added to cover telehealth services this year. Although there were no fresh requests to CMS to add new codes for 2020 CMS proposed adding new codes to the covered Medicare telehealth service list from the perspective of the services.

 Complete list can be downloaded from this link.

Now included in the final rule, CMS proposed to add new codes for 2020 which are

  1. HCPCS code GYYY1: Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month.
  2. HCPCS code GYYY2: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month.
  3. HCPCS code GYYY3: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (List separately in addition to code for primary procedure).

CMS has categorized telehealth services to fall under one of the categories defined and until the 10th of February every year, providers can request to add or delete services from this list. Broadly speaking, category 1 includes services that are similar to remote consultation, visit, therapy, and other telehealth services. Category 2 does not limit the scope of services rather it is focused more on demonstrating health benefits for patients. Every year when providers request to add or delete new codes to covered telehealth services, they must define the category of the proposed change.      

The propose telehealth codes in 2020 have been added to category 1 and would come in effect from January 1, 2020. CMS has also made changes to the limitation of geographic location in the final rule to accommodate diagnoses and treatment of the patients of substance use disorder (SUD). This would allow patients with substance use disorder (SUD) to avail of any telehealth facility including their home.

Telehealth rules and regulations are currently at an evolutionary stage and CMS is acting flexibly when considering reimbursements telehealth services. This is why starting this year CMS has considered reimbursing all those services that were remotely provided and still not come under the define boundaries of “Medicare telehealth services. These services include virtual check-ins, remote analysis of the patient health information and consultation provided via internet-based communication technologies. 

Although, patients availing telehealth services have to pay higher premiums and there are increased copay but telehealth is taking a start and every passing year would make it a norm. In the final rule, CMS has expanded the reimbursement plateau for remote patient monitoring services delivered. “These new changes to RPM services advance the ability to improve the patient care experience and allow more cost-effective business models,” said Nathaniel Lacktman who chairs national Telemedicine & Digital Health Industry Team. For the past few years, reimbursement for telehealth services provided by health care providers has been a dilemma in the absence of clearly defined codes and rules by the national agencies. This is why health care services providers were slow to adopt telehealth but the recent changes have pushed the transformation again and all the stakeholders now seem more interested in it. The inclusion of the new telehealth codes for 2020 is a welcome move that would provide enough impetus to health care services providers.