Avalere: One-third of physician services now eligible for telehealth reimbursement

Doctor on computer
To ensure they are getting reimbursed appropriately, physicians should engage with their payer representatives and local payer policy guidance regarding best practices for billing and coding. (Getty/Vladdeep)

One in 3 physician services are eligible for reimbursement via telehealth based on existing as well as new temporary federal payment policies put in place due to the COVID-19 pandemic, according to a new analysis.

The analysis, released this week from consulting firm Avalere Health, finds 191 physician procedure codes are now billable via telehealth.

In a bid to help support practices during the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) last month agreed to pay for virtual visits at the same rate as in-person visits while the coronavirus emergency remains in effect.

CMS is waiving certain Medicare telehealth payment requirements to enable telehealth services to be provided in all settings, including a patient's home. The agency also agreed to pay physicians for patient visits that take place by telephone to help practices stay open by providing them with needed revenue.

Clinicians can provide remote patient monitoring services to patients with acute or chronic conditions as well as patients with only one disease. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry.

As of March 30, CMS is now allowing more than 80 additional services through telehealth due to the COVID-19 pandemic, according to Avalere.

RELATED: Trump administration opens up access to telehealth services during coronavirus outbreak

Physician practices are taking advantage of the expanded flexibilities, and the use of telehealth has surged. Close to half of doctors are now using telehealth to treat patients, up from 18% just two years ago, according to a survey by Merritt Hawkins.

Avalere examined the impact COVID-19 telehealth policies on providers and which physician specialties are now eligible for reimbursement.

“There are numerous flexibilities and procedure types reimbursable via telehealth,” said Tim Epple, principal at Avalere Health.

For certain specialties, 90% or more of Medicare payments are eligible for reimbursement via telehealth, based on Avalere’s assessment of commonly performed services per specialty.

Physicians can leverage these flexibilities to proactively engage with patients and stem revenue losses due to declining in-person visits, Epple said.

RELATED: Half of physicians now using telehealth as COVID-19 changes practice operations

Avalere was able to break down the impact of these COVID-19 telehealth policies by specialty.

For primary care physicians, 96% of estimated Medicare fee-for-service payments are eligible for telehealth reimbursement, and for endocrinologists, 93% of payments can be billed via telehealth.

However, for gastroenterologists, only 29% of Medicare payments can be reimbursed through telehealth visits.

Avalere assessed the top 50 Medicare fee-for-service Current Procedural Terminology (CPT) codes utilized by physicians billing under relevant specialty types to assess the existing and recently granted telehealth coverage by each specialty type. The top 50 CPT codes generally represent between 85% and 95% of total Medicare payments to each specialty and serve as a rough proxy for average Medicare fee-for-service practice revenue.

RELATED: Physician groups say decision by CMS to pay for patient visits via telephone will help revenue-strapped practices

Generally, commercial payers have followed CMS’ lead in terms of expanding telehealth flexibility on a regional and local level, Epple said.

Health plans such as UnitedHealthcare, Aetna, Anthem and Excellus have recently made public announcements of changes to their telehealth policies including the addition of codes to the covered telehealth list, waiving originating site requirements and waiving member cost-sharing.

Epple advises physicians to proactively engage with their payer representatives and local payer policy guidance regarding best practices for billing and coding.

“Commercial payers in different geographies may be using different billing and coding practices to appropriately identify visits for telehealth reimbursement, such as using some type of modifier, or using a place of service notation," he said. "Understanding these nuances specific to a given practice’s payers are the best way to ensure they’re getting reimbursed appropriately."

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