If COVID is Ebbing Away, What Does It Mean for Telehealth Codes?

During the COVID-19 pandemic, mandatory social distancing and the lack of effective treatments have made telemedicine the safest interactive system between patients and providers. Government authorities dramatically expanded telemedicine access during the pandemic. But as COVID is ebbing away and public health emergencies (PHE) in many states are ending, how does it will impact telehealth services? Patients and providers worry they’ll lose the benefits of remote care and are unaware of telehealth codes post PHE environment. For example, when Virginia’s public health emergency (PHE) ended, providers were forced to cut off telehealth services to their patients because of shifting rules in multiple states. All this is impacting hundreds of thousands of patients across the United States seeking telehealth services. 

Meanwhile, some doctors are in dilemma whether to drop patients or risk practicing without payment or a license. While some patients are driving to nearby states and doing telehealth visits roadside to avoid breaking rules regarding out-of-state doctors. As COVID-19 blazed across the country, nearly every state relaxed its licensing rules so outside physicians could provide telemedicine. Previously, doctors had to complete lengthy forms and pay steep fees to get a license in every state where a patient received remote care. Getting physicians additional medical licenses is no simple matter. The process in some states is extremely tedious, time-consuming, and expensive, and it hampers patient care. 

Telehealth Codes Before and After PHE

Before the COVID-19 pandemic, Medicare-covered telemedicine only for rural patients and only if they traveled to certain health care sites. But during PHE, the Centers for Medicare & Medicaid Services (CMS) made a dramatic change, it allowed Medicare coverage of telehealth for any patient, anywhere, as well as payment equal to in-person visits. CMS telehealth codes includes Telehealth Visits (99201-99215, G0425-G0427); Virtual Check-ins (G2010, G2012, G2250, G2251, G2252); E-Visits (99421-99423, G2061-G2063); Telephone Services (99441-99443); and Interprofessional Telephone/Internet/EHR Consultations (99446-99449, 99451,99452). 

Now, a key question is how long the government will extend the PHE declaration. Now, states are beginning to retighten their licensing rules for telehealth services. At least half have already done so, and others are soon to follow. But once the PHE lapses, Medicare will once again exclude in-home telemedicine and coverage to anywhere other than rural areas. The only exceptions will be most remote substance use and mental health services, which were addressed under prior legislation. In addition to the geographic issues, observers are watching Medicare’s list of covered services. During the pandemic, CMS added dozens of services, from eye exams to speech therapy, to its list of covered telehealthcare. Now CMS is weighing which of those to renew. The proposal would extend coverage until the end of 2023 to allow further research. A longer-term solution would be the permanent extension of Medicare’s current telehealth coverage, but that would require congressional action. 

Uncertainty After PHE

During the pandemic, many states issued rules requiring private insurers to cover virtual visits. As their PHEs end, some states are retaining those coverage requirements, at least temporarily. For example, Maryland is extending many loosened telemedicine rules for more than a year to permit further assessment of the approach. Even if states continue to require insurers to cover telehealth, a major variable is whether payers will be required or choose to reimburse telemedicine at the same level as in-person care. Currently, less than half of states mandate parity for remote care. Even if states continue to require insurers to cover telehealth, a major variable is whether payers will be required or choose to reimburse telemedicine at the same level as in-person care. Currently, less than half of states mandate parity for remote care.

We Are Here to Help.

MedicalBillersandCoders (MBC) is a leading medical billing company providing complete revenue cycle services. We assisted solo providers, group practices, hospitals, and large healthcare organizations in getting accurate telehealth reimbursement during pandemics. As medical billing experts, we keep a close eye on changing legislation and reimbursement guidelines for various states. We can help you in medical billing and coding for telehealth services during such uncertain times. To know more about our telehealth billing and coding services, contact us at info@medicalbillersandcoders.com/ 888-357-3226

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