Yesterday, the Centers for Medicare and Medicaid (CMS) provided guidance on the expanded access to TeleHealth visits in order to provide more beneficiaries with healthcare options that allow for social distancing during the COVID-19 pandemic. Under waiver 1135 authority, CMS is removing the requirements for beneficiaries to begin utilizing TeleHealth visits while relaxing the enforcement of regulations on clinicians providing virtual services.

Under Medicare, clinicians can provide three types of virtual services: TeleHealth visits, Virtual Check-Ins, and E-Visits.  TeleHealth visits refer to a list of services that are normally performed in person that may also be furnished through telemedicine.  Virtual Check-Ins are brief (5-10 minutes) communications, via phone or other telecommunication device, between patients and practitioners to determine if an in-person visit is needed. E-Visits are conducted through a patient portal and are generally considered virtual evaluation and management services, with specific sets of CPT codes designating time spent with the patient.

CMS has suspended the requirement that a beneficiary be located in a rural area and temporarily removed the ‘originating site’ requirements for TeleHealth visits, meaning beneficiaries may now receive Telehealth visits in their home or other care settings.  The term ‘originating site’ refers to where beneficiaries receive medical services through a telecommunications system, which was previously limited to a physician’s office or authorized healthcare facilities.

The Department of Health and Human Services (HHS) will not enforce the established patient requirement by halting audits which ensure a prior relationship existed for claims submitted during the public health emergency. Additionally, the HHS Office for Civil Rights (OCR) will exercise discretion and waive penalties for HIPAA violations for providers that operate in good faith when serving patients by using everyday technologies such as Skype or Facetime. Anti-kickback rules requiring cost-sharing for Telehealth services will be enforced at discretion of the HHS Office of the Inspector General during the public health emergency.  This will allow providers to reduce or waive cost-sharing for TeleHealth services without penalty if they so choose.

CMS is not making changes to the billing process under the waiver.  Medicare TeleHealth visits are generally billed as if the service had been furnished in-person. For Medicare TeleHealth visits, the claim should reflect the designated Place of Service (POS) code 02-Telehealth, to indicate the billed service was furnished as a professional telehealth service from a distant site.  The facility payment rate will be used for services that have different rates depending on if a service is performed in an office versus a facility. CMS is not requiring any additional modifiers when billing for TeleHealth services but maintains current rules which require modifiers for three scenarios. For additional information from Matt Reiter with the HBMA on billing for TeleHealth services, including Virtual Check-Ins and E-Visits, CLICK HERE.

These policy changes apply specifically to Medicare’s coverage of TeleHealth services.  However, CMS did issue recommendations to states on how to align Medicaid programs with the updates. Commercial payers have followed CMS’s efforts to respond to COVID-19, with many also opting to expand TeleHealth access.  For a summary of updates by payor, CLICK HERE.

CMS will continue the waiver of TeleHealth visit requirements until the end of the public health emergency is declared by the Secretary of the HHS.  As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.


Kayley Jaquet

Manager of Regulatory Affairs