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The Long and Winding Path to Telemedicine Reimbursement

While the AMA's Telehealth Services Workgroup looks to identify new CPT codes, groups like the American Telemedicine Association are lobbying CMS to open the pursestrings for new services

By Eric Wicklund

- The push is on to increase reimbursement for telemedicine, with both the American Medical Association and American Telemedicine Association looking to create more CPT codes.

ATA officials announced this week that they’ll be submitting suggestions for new CPT codes to the Centers for Medicare & Medicaid Services by the end of this month, with a particular emphasis on telerehabilitation services. The ATA is leading the effort to have CMS recognize more telemedicine services and therefore reimburse physicians who use them.

The AMA, which oversees the Current Procedural Terminology codeset, has launched a workgroup to develop new codes. New reports indicate the 50-member panel is particularly interested in remote visit tools and chronic disease management apps.

"The CPT code set is the foundation upon which every participant in the medical community - physicians, hospitals, allied health professionals, payers and others - can efficiently share accurate information about medical services," AMA President Steven J. Stack, MD, said in an October press release announcing the workgroup’s launch. "Input from the Telehealth Services Workgroup will help the CPT code set reflect new technological and telehealth advancements available to mainstream clinical practice, and ensures the code set can fulfill its role as the health system's common language for reporting contemporary medical procedures."

The workgroup’s recommendations will be sent to the AMA’s CPT Editorial Board, which develops the codeset for physician billing. The group’s efforts may dovetail with recent action by CMS to create new codes that would reimburse for annual telehealth visits, psychoanalysis, psychotherapy and long-term evaluation and management services.

Last month CMS added new CPT codes to its final rules for payments to physicians and hospitals. Scheduled to take effect next year, CPT codes 99356 and 99357 focus on prolonged care in an inpatient of hospital setting, with certain conditions, while codes 90963-90966 focus on telehealth care for patients receiving home dialysis for end-stage renal disease.

CMS introduced seven codes to its 2015 Medicare physician fee schedule that offer some reimbursement for telemedicine used for psychotherapy, prolonged office visits and annual wellness visits. The most notable of those codes, 99490, enables physicians to be reimbursed at an average rate of $42 per patient per month for non-face-to-face chronic care management (CCM) services.

While physicians and telehealth advocates hailed the codes as a step in the right direction, many also noted they aren’t easy to use. Experts say many physicians are leaving thousands of dollars on the table by skipping the codes.

In a survey conducted this fall by SmartLink Mobile systems, 84 percent of physicians said the CCM program is having a positive impact on patient care and 70 percent expect to take part in it, but less than 20 percent are actually using CPT code 994990, and 70 percent said they don’t understand how to use it.


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