Interim Final Rule with Comment Period Establishes Increased Payments for Audio-only Telephone Services

In the March 31 COVID-19 Interim Final Rule with comment period, the Centers for Medicare and Medicaid Services (CMS) established separate payment for audio-only telephone evaluation and management services. CMS acknowledges that audio-only services are currently serving as a substitute for office outpatient Medicare telehealth visits for beneficiaries who do not have access to audio-video technology.  Accordingly, on April 30, the agency established payments for these codes that are analogous to office outpatient E/M services (99212-99214) and is relaxing enforcement of the “established patient” descriptor. This action increases payments for the services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020. Although this new payment policy currently applies to Medicare physicians and patients only, we are hopeful that private insurance plans and state Medicaid plans will follow suit and adopt similar policies.
The telephone evaluation and management (E/M) services are CPT codes:

• 99441 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion);
  
  
• 99442 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion); and
  
  
• 99443 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion).

Other commonly used psychiatry codes that have been approved for audio-only telephone services:

• 90785 – Psychiatric interactive complexity
• 90791-2 – Psychiatric diagnostic services
• 90832-34, 36-38 – Psychotherapy services
• 90839-40 – Crisis services
• 90845 – Psychoanalysis
• 90846-47 – Family therapy services
• 96116 – Neurobehavioral status examination
• 90853 – Group psychotherapy

The Centers for Medicare and Medicaid Services (CMS) has developed a new toolkit intended to help states identify impediments to the rapid deployment of telehealth in Medicaid and CHIP. CMS is encouraging states to facilitate clinically appropriate telehealth services in the Medicaid and CHIP programs and has developed this toolkit to assist states with the policy considerations necessary to accomplish this goal. The document addresses the pediatric population and how state laws affect the age of consent, among other issues. A checklist of policy questions for consideration in assessing capacity to provide telehealth and a list of frequently asked questions are also included.

This toolkit could be helpful to AACAP members who are advocating for greater flexibility to provide telehealth services in their own state, especially in the time of Covid-19.

The Centers for Medicare and Medicaid Services (CMS) has announced that monies from the Provider Relief Fund have begun to flow. These funds were part of the CARES Act, signed into law on March 27, 2020, and are intended to provide immediate financial relief to physicians and hospitals who are on the front lines treating Covid-19 patients. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get testing and treatment for COVID-19. For additional details on the funding and eligibility, please visit the Provider Relief Fund webpage. The funds have been allocated as follows:

• $50 billion general allocation to Medicare facilities: Funds received will be based on eligible providers' 2018 net patient revenue, automatically distributed based on cost reports. Those without cost report data can use the new Attestation Portal established for this purpose. Eligibility for a portion of these funds is contingent on having received Medicare reimbursements in 2019.

• $10 billion allocation to Covid-19 hotspots such as New York:  Funds from this allocation are being made available to hospitals, and there are several submission requirements to obtain funds. 

• An unspecified portion will be allocated for the treatment of individuals who are uninsured: This will provide reimbursement to physicians and health care providers at Medicare rates for Covid-19 related treatment of individuals who are uninsured. Every health care provider who has provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursement through the program and will be reimbursed at Medicare rates, subject to available funding. Physicians can find out more information, and register for the program here starting April 27. Claims can be submitted starting in May of 2020.

• $10 billion for rural providers: These funds will go to rural health clinics and hospitals who often run on very thin financial margins.

• $400 million to the Indian Health Service. 

• Additional Allocations: These funds will be provided to other health care facilities and providers such as skilled nursing facilities, dentists, and providers who solely take Medicaid.

This information will be updated as AACAP learns more about the funding being made available to physicians and healthcare facilities.

Funds appropriated by the Coronavirus Aid, Relief, and Economic Security (CARES) Act are being made available to promote telehealth services through the COVID-19 Telehealth Program. The Federal Communications Commission (FCC) announced eligibility and the application process late last week. The funds are being made available to:  (1) post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools; (2) community health centers or health centers providing health care to migrants; (3) local health departments or agencies; (4) community mental health centers; (5) not-for-profit hospitals; (6) rural health clinics; (7) skilled nursing facilities; or (8) consortia of health care providers consisting of one or more entities falling into the first seven categories. The funding will cover telecommunications services and broadband connectivity services, information services, and internet connected devices/equipment. The FCC will distribute $200 million in funding to eligible entities on a rolling basis until they are expended, or the current pandemic is over. AACAP members who work within eligible sites are encouraged to apply.

A fillable application for the program and further details can be found here. Additional questions about the application process can be submitted to EmergencyTelehealthSupport@fcc.gov, a dedicated email account established for this purpose.