The Centers for Medicaid & Medicare Services (CMS) recently released the 2021 Physician Fee Schedule (PFS) Final Rule. The PFS Final Rule is scheduled to be published on December 28, 2020, but an unpublished version may be accessed here. CMS has also issued a fact sheet, which overviews the changes made by the 2021 PFS Final Rule. The fact sheet may be accessed here.
By way of background, the Trump Administration had greatly expanded telehealth as a means to counteract the spread of COVID-19 during the COVID-19 public health emergency (PHE). Since the beginning of the pandemic, CMS has added 144 telehealth services to the list of Medicare-covered services. CMS believed adding such services would promote safe access to healthcare during the pandemic. CMS’ action resulted in over 24.5 million Medicare beneficiaries receiving telemedicine services during the pandemic. For comparison, CMS reported that only about 15,000 beneficiaries received Medicare telemedicine services on a weekly basis prior to the pandemic.
Through the PFS Final Rule, CMS is making many of these changes permanent. For example, the following services have been permanently added to the Medicare telehealth list on a Category 1 basis:
- Group Psychotherapy (CPT code 90853);
- Psychological and Neuropsychological testing (CPT code 96121);
- Domiciliary, Rest Home, or Custodial Care services for established patients (CPT codes 99334-99335);
- Home visits for established patients (CPT codes 99347-99348);
- Cognitive assessment and care planning services (CPT code 99483);
- Visit complexity inherent to certain office/outpatient E&M (HCPCS code G2211); and
- Prolonged services (HCPCS code G2212).
CMS also created a new category for telehealth services, Category 3, which will serve as a temporary category for adding services to the list of Medicare telehealth services. CMS finalized the following list of services to be added on a Category 3 basis:
- Home Visits, Established Patient (CPT codes 99349-99350)
- Emergency Department Visits, Levels 1-5 (CPT codes 99281-99285)
- Nursing facilities discharge day management (CPT codes 99315-99316)
- Psychological and Neuropsychological Testing (CPT codes 96130-96133; CPT codes 96136-96139)
- Therapy Services, Physical and Occupational Therapy, All levels (CPT codes 97161-97168; CPT codes 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507)
- Hospital discharge day management (CPT codes 99238-99239)
- Inpatient Neonatal and Pediatric Critical Care, Subsequent (CPT codes 99469, 99472, 99476)
- Continuing Neonatal Intensive Care Services (CPT codes 99478-99480)
- Critical Care Services (CPT codes 99291-99292)
- End-Stage Renal Disease Monthly Capitation Payment codes (CPT codes 90952, 90953, 90956, 90959, 90962)
- Subsequent Observation and Observation Discharge Day Management (CPT codes 99217; CPT codes 99224-99226)
The expansion of telehealth is not only meant to benefit Medicare beneficiaries during the PHE, but also to expand the availability of health care to beneficiaries in rural areas. The expansion should ensure that rural Medicare beneficiaries are able to continue to have access to the telehealth services they need. This is a key aspect of the Trump Administration’s Executive Order on Improving Rural and Telehealth Access.
The 2021 PFS Final Rule also clarified that licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech-language pathologists may furnish the following: (1) online assessment and management services; (2) the online assessment; (3) virtual check-ins; and (4) remote evaluation services. Further, CMS has established a payment policy for a new HCPCS G-code for certain E/M services. Under the new HCPCS G-code, CMS will compensate providers for 11-20 minutes of medical discussion with patients to determine the necessity of an in-person visit.
Lastly, CMS adopted a temporary policy during the COVID-19 PHE which revised the definition of direct supervision so that it would include the virtual presence of a supervising physician or practitioner using real-time, interactive audio/visual communications technology. CMS adopted this policy to limit beneficiaries’ potential exposure to COVID-19. The 2021 PFS Final Rule extends this temporary revision until the end of the PHE or December 31, 2021, whichever is later.
For any questions regarding the 2021 PFS Final Rule, please contact Abby Pendleton at apendleton@thehlp.com, or your regular HLP attorney, or Partners@thehlp.com, or call (212) 734-0128 or (248) 996-8510.