Physician fee schedule increases reimbursable telehealth services

The 2016 Medicare Physician Fee Schedule includes some good news for proponents of telehealth. 

The Centers for Medicare and Medicaid Services (CMS) added several services to the list of those eligible for reimbursement when delivered through telehealth. The following codes will be reimbursable (subject to CMS’ other restrictions) under Medicare beginning Jan. 1, 2016, via telehealth:

• 99356 – Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service (the first hour)
• 99357 – Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service (each additional 30 minutes)

These codes can only be billed in conjunction with subsequent hospital and nursing facility codes, and is limited to one subsequent hospital visit every three days, and one subsequent nursing facility visit every 30 days.

CMS also added the end-stage renal disease (ESRD) codes: 90963, 90964, 90965, 90966 to the list. These codes are ESRD-related services for home dialysis per full month. Although the home isn’t an eligible site for Medicare telehealth services, CMS said “we recognize that many components of these services would be furnished from an authorized originating site and, therefore, can be furnished via telehealth.” The required clinical examination of the catheter access site has to be furnished in-person. 

CMS also added new eligible providers to the fee schedule. “Certified Registered Nurse Anesthetists (CRNAs) as Practitioners for Telehealth Services” is now on the list although they were originally omitted from the regulations as an eligible provider because it was thought CRNAs would not provide services via telehealth. “CRNAs in some states are licensed to furnish certain services on the telehealth list, including E/M services,” CMS wrote in the regulation.

The rule also increases the telehealth facility fee to $25.10 from $24.83 in FY 2015.