Telehealth Gets More Coverage from CMS

Among the new rules are provisions that will pay for remote chronic care management. "The combination of the chronic care management code and being able to use it in conjunction with monitoring of those chronic conditions is a big step forward," says the American Telemedicine Association.

UPDATED NOV 14 to reflect corrections issued by The American Telemedicine Association addressing inaccuracies in its Nov 1 media release.

New rules from the Centers for Medicare & Medicaid Services significantly broaden coverage for chronic care telehealth services.

The rulemaking changes are inside the 1,185-page document detailing Medicare payments to physicians and other providers.

The American Telemedicine Association, which had sought the expanded coverage for five years, notes that among the rules are provisions that will pay for remote chronic care management using the new current procedural terminology (CPT) code 99490, with a monthly unadjusted, non-facility fee of $42.60.

"For us, it was more important to begin to specifically address chronic care," says Gary Capistrant, senior director of public policy at ATA. "The combination of the chronic care management code and being able to use it in conjunction with monitoring of those chronic conditions is a big step forward and a very substantial change for Medicare."

Capistrant says the new rules also represent an acknowledgement by CMS that reimbursing for chronic care could prove to be cost effective.

"It's an important policy move. Whether it is sufficient, time will tell, but it is certainly a step in the right direction and an important initiative," he says. "There has been a lot of focus on primary care, even with the Medicare population. That may be the 80% of the people but it is only 20% of the problem. There's an increasing emphasis on looking at the 80% of the problem that is 20% of the people, and that is chronic and specialty care. They understand that the government is spending a huge amount for chronic care conditions and that there is a value managing those to reduce the overall expenditures."

As a practical matter, Capistrant says, the new evaluation management code for chronic care management will be a much more commonly used because "it's a better fit between management and monitoring."

As for the reimbursements, Capistrant says "only time will tell whether those amounts are sufficient to get physicians to focus on chronic care management and monitoring. I think it will be attractive to physician community, geriatricians and others who deal with these chronic conditions."

"First, they'll have to see what is involved in being a chronic care manager and to what extent you want to add that to your practice. It may involve some internal staff changes," he says. "There are services required that a lot of physicians just don't do right now, in part because they are not paid for it. This is probably the kind of thing that physicians may not be too interested in doing for one or two patients, but if they can get 100 or 200 patients then they've got the economies of scale going to make it work right."

Hospitals might also take a greater interest in chronic care management if only to avoid readmissions penalties. "More than 2,000 hospitals have a penalty this year in their Medicare rates because of readmissions," Capistrant says. "There is an increasing demand for this kind of service and it fits together."

The new rules also include seven new covered procedure codes for telehealth, including annual wellness visits, psychotherapy services, and prolonged services at physicians' offices.