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CMS: Many Telehealth Codes Are Here to Stay, But First Visit Will Be in Person Post-PHE

A top CMS official said Nov. 17 that the expansion of telehealth is the “most transformative of things” it has done in the past 10 months since the declaration of the COVID-19 public health emergency (PHE). That statement may explain why Medicare coverage of telehealth services will stay in place to some degree when the PHE is over.

“I can safely say when it comes to telehealth, we will be keeping a lot of those services,” Kimberly Brandt, CMS’s principal deputy administrator for operations and policy, said at the Health Care Compliance Association’s virtual Healthcare Enforcement Compliance Conference.[1]

Eventually, however, Medicare will require physicians to see new patients in person the first time, she said. Although physicians and other practitioners are now permitted to bill Medicare for services delivered by telehealth even without an established relationship, that will end with the PHE. “We want to make sure we get back to aligning the initial visit to something in person,” Brandt explained. “We are conscious of the fact that it is something that potentially could be a bit of a fraud issue.”

Brandt described how the pandemic was the inflection point for telehealth. “It has really been one of the things we have had to change our entire thinking about to ensure the continuity of treatment for Medicare beneficiaries.” Brandt said 26% of Medicare fee-for-service beneficiaries are now using telemedicine, a 1,100% increase since CMS on March 6 expanded telehealth services and the types of providers who can deliver them in the first of four COVID-19 interim final rules[2] with comment periods. She said 146 CPT codes have been added to the Medicare telehealth services list, 89 of which are approved for audio-only delivery.

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