CMS proposes expanded telehealth coverage for 2015

Annual wellness visits and psychotherapy are among four services the Centers for Medicare & Medicaid Services proposes that Medicare beneficiaries can receive via telehealth, according to a proposed update to the Medicare Physician Fee Schedule (PFS) for the 2015 calendar year issued late Thursday.

Under the proposal, annual wellness visits and psychotherapy, as well as psychoanalysis and "prolonged evaluation and management services," would be covered as Category 1 services. Such services, according to CMS, are defined as "similar to professional consultations, office visits and office psychiatry services" currently covered by the agency.

Wellness visits, CMS says, would include a personalized prevention plan of service, an initial visit and a subsequent visit.

Prolonged evaluation and management services, according to the agency, would include "prolonged service in the office or other outpatient setting" that required direct patient contact beyond usual care; CMS provided coding for both the first hour beyond such care, and each additional 30 minutes.

"Although we expect these changes to increase access to care in rural areas, based on recent utilization of similar services already on the telehealth list, we estimate no significant impact on PFS expenditures from the proposed additions," CMS says.

The rule is set to be published in the Federal Register on July 11.

The proposed rule also includes changes to relative value units for calendar year 2015 and creates a process for added transparency in developing payment rates. It also issues provisions related to implementing separate payment for chronic care management services.

Additionally, it proposes changes to the ambulance fee schedule regulations, the Physician Compare Website, the Physician Quality Reporting System, the Medicare Shared Savings Program, the Value-Based Payment Modifier and the Physician Feedback Program.

The agency will accept comments on the proposal through Sept. 2.

To learn more:
- here's the proposed rule (.pdf)
- read this fact sheet

Report

Driving Engagement in an Evolving Healthcare Ecosystem

Deep-dive into evolving consumer expectations in healthcare today and how leading providers are shaping their infrastructure to connect with patients through virtual care.

Suggested Articles

UnitedHealth Group and Eli Lilly are teaming up to further study the effects of the drugmaker's antibody therapy bamlanivimab in high-risk patients.

UPMC Health Plan is expanding its medication adherence program with Sempre Health to include diabetes medications.

Welcome to this week's Chutes & Ladders, our roundup of hirings, firings and retirings throughout the industry.