Expanded telehealth reimbursement included in 2018 PFS

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The proposed Medicare Physician Fee Schedule (PFS) rule would provide a boost in reimbursement to telehealth services, paying for several new services and codes as suggested by telehealth practitioners to CMS.

In the 2018 proposed rule, the following codes would be added to the list of covered telehealth services:

  • CPT code 90785: Interactive complexity
  • CPT codes 96160 and 96161: Health risk assessment
  • CPT codes 90839 and 90840: Psychotherapy for crisis
  • HCPCS code G0506: Care planning for chronic care management
  • HCPCS code G0296: Visit to determine low dose computed tomography eligibility

. Several more suggested additions, such as services related to physical, occupational, and speech therapy, as well as initial hospital care, were rejected.

In the 2017 rule, new codes were added for end-stage renal disease-related services, advanced care planning, and critical care consultations. Like those changes, if the services make into the final rule, CMS would reimburse eligible telehealth providers at the same rate as if those services were delivered in an office visit.

The proposed rule would result in a net 0.19 percent reduction to payments after making adjustments for potentially misvalued services. Groups like the American Medical Association, however, found positives in the proposed rule’s expansion of the Medicare Diabetes Prevention Program, delay of the appropriate use criteria for advanced imaging services and request for regulatory relief suggestions from stakeholders.

“The AMA applauds CMS’ invitation for public comment on ideas for regulatory, sub-regulatory, policy, practice and procedural changes to improve the health care system by reducing unnecessary burdens for clinicians, other providers, patients and their families,” the association said in a statement. “After extensive discussions with the Administration about regulatory relief, the AMA welcomes this positive step by CMS.”