In 2020, we saw an unprecedented amount of healthcare providers begin to offer telehealth services as a way to keep both patients and physicians safe from the pandemic.  Insurance companies subsequently increased their coverage for telehealth services to support the widespread use of telemedicine.  Alongside private insurance companies, Medicare has also allowed for more coverage and easier access for beneficiaries.  Before COVID-19, only about 15,000 beneficiaries per week leveraged telemedicine services. Now, 24.5 million out of 63 million beneficiaries, nearly 40%, have used telehealth to obtain medical services since the start of the pandemic. 

The previous administration has put into place both temporary and permanent measures to protect this extended Medicare coverage throughout the public health emergency. Here, we’ve detailed all of the most recent changes to Medicare telehealth service coverage, so that your wellness business can be prepared to serve your Medicare patients through 2022. Interested in transitioning your practice to telehealth? Learn how you can set up a free Starter account with Healthie’s EHR + telehealth platform by clicking here.

Types of Virtual Services 

Currently, under Medicare Part B, there are three different mediums of virtual services that can be provided by physicians and other professionals to Medicare beneficiaries. 

The first is Medicare Telehealth Services.  These are services that occur using synchronous telecommunications technology and traditionally occur in the office or hospital.  Technically, the patient should have a prior relationship with the physician for reimbursement on medicare telehealth. Physicians are paid the same rate as regular, in-person visits.  Usually, beneficiaries must join the appointment from an approved site, such as a hospital or clinic, but now they may join the appointment from home and still receive the same coverage. 

The second is Virtual Check-Ins.  These are exactly as the name describes: established beneficiaries may have a brief communication service with their physician via a variety of telecommunications methods, whether synchronous or asynchronous.  Virtual check-ins are put in place so that beneficiaries can avoid unnecessary trips to the doctor’s office, to decrease their risk of contracting COVID-19.  Virtual check-ins can be billed using HCPCS codes G2012 for synchronous and G2010 for asynchronous communications. 

The third is E-Visits.  E-Visits include non-face-to-face patient-initiated virtual communications with their physicians, typically through a patient portal.  Medicare telehealth E-Visits also include any evaluation and management visits that may occur with beneficiaries.  These types of visits can be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063. If you want to learn more about billing clients through their insurance, Healthie can help with our Free Starter Plan. Simply click here to learn more. 

Types of Medicare Services Covered

Earlier in 2020, the CARES Act allowed the Department of Health and Human Services to temporarily lift the originating site and geographic restrictions on Medicare’s coverage of telehealth services.  Prior to this change, wellness providers were not allowed to provide telehealth services outside of rural areas, and beneficiaries could not receive these services unless they traveled to a healthcare facility.  These restrictions essentially defeat the purpose of telehealth, which hopes to allow patients to receive care from the comfort and safety of their own homes.  While this ease of restrictions is still in place, Medicare does not have the authority to permanently expand telehealth coverage beyond rural areas at this time, and currently, restrictions will be put back in place at the end of the public health emergency. 

Not only does medicare telehealth coverage vary depending on the method of delivery for telehealth services, but also the type of service being rendered. Since March of last year, 144 telehealth services have been added to Medicare’s list of covered services, including physical and occupational therapy, emergency visits, and renal dialysis services. In December, the previous administration released the Physician Fee Schedule Final Rule, which included adding more than 60 services to the covered Medicare telehealth list.  These services, called Category 3 services, will be covered through the end of the calendar year in which the pandemic ends; so they will at least be covered through the end of 2023.  Some of these services include group psychotherapy, psychological and neurological testing, and cognitive assessment and behavioral planning services.  

You can find a list of all Medicare covered telehealth services and corresponding billing codes, current as of January 14, 2023 here. 

Future Legislation Protecting Medicare Telehealth Coverage

In July of 2020, the Telehealth Modernization Act of 2020 was introduced. This bill would permanently remove many of the restrictions on telehealth that were temporarily lifted at the start of the pandemic.  These restrictions mainly include the geographical limits placed on medicare telehealth services. This bill would also allow the HHS secretary the ability to help Medicare patients access telehealth from physical therapists, speech pathologists, and other professionals who have been newly introduced to telehealthcare for their specialty.  Lastly, the bill would allow Medicare to cover more types of services that are covered by telehealth.  It’s estimated that physicians are seeing 50-175 times the amount of patients via telehealth than they did before the pandemic; so, lawmakers and physicians see no reason to backtrack the progress made over the past year in expanding telehealth access. 

While this bill did not make it past the House floor last summer, in January, a group of bipartisan lawmakers reintroduced it to the House as the Protecting Access to Post-COVID-19 Telehealth Act. It maintains the goal of eliminating most geographic and originating site restrictions on the use of telehealth and Medicare.  Additionally, it would prevent the sudden loss of medicare telehealth coverage for virtual services at the end of the public health emergency, allowing for reimbursement for 90 days post-COVID. It would also allow for expanded coverage during future public health emergencies.  Lastly, this act would require a study to be conducted on the use of telehealth during COVID-19. 

The status of the bill is still unknown, but legislation such as this is crucial to the expansion and development of telehealth throughout the health and wellness profession.  Establishing clear paths of coverage for a wider base of beneficiaries, as well as a wide variety of services, will allow millions of Americans to receive necessary healthcare from the safety of their own homes.  

Using Healthie for Medicare & Telemedicine  Reimbursement

Healthie’s practice management and telehealth platform allows you to host virtual appointments with clients and easily generate and submit insurance claims using CPT and GT modifier codes for reimbursement. To set up a Starter account for $0 today, click here.

• Secure Patient Portal: Each patient receives a secure log in to their Healthie Client Portal, which allows them to electronically complete paperwork, book appointments, and communicate with their healthcare provider. 
• EHR: By leveraging Healthie’s HIPAA-compliant electronic health record, it allows you to keep clients’ personal health information secure, and track client progress using custom-built chart notes.
• Telehealth: Offer HIPAA-compliant individual and group video sessions to Medicare patients. Healthie’s built-in telehealth feature allows you to connect with patients, complete chart notes, and host group appointments, all from one platform. 
• Insurance Billing: Easily create a CMS-1500 claim and submit to your clearinghouse directly on the Healthie platform.  Monitor claim status and store client’s telehealth insurance information throughout the billing process for simplified insurance billing. Utilize Healthie’s direct integration with Office Ally for easy claim submission. 
• Documents & Online Programs: electronically share resources including client education handouts, videos, meal plans, and more to help promote wellness change. 

See how Healthie can help you connect with clients, sell your wellness services, and streamline your business operations. Start your free trial today.