Healthcare providers nationwide now have an additional tool to promote social distancing in patient care. On Mar. 17, the Centers for Medicare and Medicaid Services (CMS) confirmed that practitioners nationwide may conduct certain healthcare visits through virtual means. Telehealth services offer providers and patients a non-face-to-face method to communicate confidentially about healthcare options. Patient consent should be obtained for these services. The CMS announcement may be found here.

Fee-for-Service Medicare Patients

CMS has expanded telehealth coverage to new and established patients regardless of geographic locality. Effective Mar. 6, Medicare will pay for office, hospital and other visits carried out via telehealth across the country, including in a beneficiary’s home. This waiver is not limited to patients with COVID-19. Medicare patients may be seen using telephones with “audio and video capabilities that are used for two-way, real-time interactive communication,” such as smartphones. Place of Service (POS) code 02-Telehealth should be included on distant site claims. Facilities may bill for the originating site facility fee under HCPCS code Q3014.

Patients with fee-for-service Medicare qualify for certain telehealth coverage. The current reimbursable codes can be found here. Medicare already covers virtual check-ins and services through online patient portals to determine whether the patient should come in for a visit and/or testing. The Medicare coinsurance and deductible still apply to these services; however, providers have flexibility to reduce or waive cost-sharing. CMS offered the following summary guidance:

A complete list of frequently asked questions is available here.

Medicare Advantage (Part C)

Medicare Advantage Plans may offer existing telehealth coverage for covered Members. Due to the COVID-19 outbreak, CMS encourages Medicare Advantage Plans to increase flexibility to provide telehealth services. Consider checking with your patient’s healthcare plans on the availability of medical services through telecommunications. Treatment and reimbursement options may be available without the need for a face-to-face visit.

State Medicaid Programs

Telehealth coverage varies for each state. CMS encourages state Medicaid programs to utilize existing Medicaid coverage or expand telehealth coverage to promote patient access. General Medicaid resources may be found here.

Commercial Insurance Payors

Several commercial insurance plans provide patient access to telehealth visits. When scheduling appointments with patients, consider a telehealth visit if the insurer permits it.