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CMS Releases Final Rule: New Additions to Telehealth Coverage for 2011

Posted Nov 02 2010 12:00am

News flash....CMS has just released its Final Rule for new additions to telehealth coverage for 2011  (see pages 486 to 526 for the major telehealth sections).  Highlights include:

  • Individual and group kidney disease education (KDE) services (HCPCS codes G0420 and G0421, respectively);
  • Individual and group diabetes self-management training (DSMT) services, with a minimum of 1 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 99231, 99232, and 99233); and
  • 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). 

CMS is also revising §410.78(b) and §414.65(a)(1) accordingly. Specifically, the agency is adding individual and group KDE services, individual and group 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 the service of the practitioner. CMS is continuing to specify that the physician visits required under §483.40(c) may not be furnished as telehealth services.

Another change includes an increase in the telehealth originating site facility fee to $24.10.

My suggestion, make sure your local/regional payors (Medicaid, private and others) are aware of CMS' new reimbursement policy andrequest that they consider making the same or similar changes.  You would be surprised at how many payors are still reimbursing at Medicare's rates from a few years ago!

 

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