CMS and extension of Telemedicine beyond the Public Health Emergency

There has been much discussion regarding the extension of Telehealth technology and communication-based services in the US beyond the COVID-19 Public Health Emergency (PHE). Indeed, the recent executive order President Trump contains the following text:

“Sec. 5. Expanding Flexibilities Beyond the Public Health Emergency. Within 60 days of the date of this order, the Secretary shall review the following temporary measures put in place during the PHE, and shall propose a regulation to extend these measures, as appropriate, beyond the duration of the PHE:

(a) the additional telehealth services offered to Medicare beneficiaries”

In the recently released document from CMS CY 2021 Revisions to Payment Policies under the Physician Fee Schedule” there is similar language to the executive order relating to the expansion of Telemedicine services that will / may be reimbursed by CMS.

CMS has a standard annual review process for Physician Fee Schedule (PFS). Several conditions must be met for Medicare to make payment for telehealth services under the PFS. Under this process CMS assigns submitted requests to add telehealth services to one of two categories:

  • Category 1: Services that are similar to professional consultations, office visits, and office psychiatry services that are currently on Medicare telehealth services list.

  • Category 2: Services that are not similar to those on the current Medicare telehealth services list.

For CY 2021, CMS is proposing (subject to public comment) the following additions to the telemedicine Service List as Category 1 items that will be of interest to Oncology Practices:

  • Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99334-99335). Typically, 15 minutes are spent with the patient and/or family or caregiver.

  • Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99334-99335). Typically, 25 minutes are spent with the patient and/or family or caregiver.

  • Home Visits, Established Patient (CPT codes 99347- 99348)

In response to the PHE for the COVID-19 CMS added a broad range of services to the Medicare telehealth services list. CMS believes that immediate removal of these services could potentially jeopardize patient access to services that have been clinical beneficial. As such CMS wishes to allow additional time to collect information from the public regarding which telehealth services have been used, and to understand how the use of these telehealth services have contributed positively to or negatively impacted the quality of services provided.

CMS is therefore proposing the creation of a THIRD category of criteria for adding services to the Medicare Telehealth services list ON A TEMPORARY BASIS.

CMS would include in this category the services that were added during the PHE for which there is likely to be clinical benefit when furnished via telehealth, but for which there is not yet sufficient evidence available to consider the services as permanent additions under Category 1 or Category 2 criteria.

Category 3 would ultimately need to meet the criteria under categories 1 or 2 in order to be permanently added to the Medicare Telehealth Services list. The potential for evidence development that could continue through the Category 3 temporary addition period was considered for each of the services added on an interim final basis during the PHE.

Any service added under the proposed Category 3 would remain on the Medicare telehealth services list through the calendar year in which the PHE ends (likely end of 2021).

The following services are proposed for temporary addition to the medicare telehealth services list:

  • Domiciliary, Rest Home, or Custodial Care services, Established patients. (CPT Codes 99336-99337 )

  • Home Visits, Established Patient. (CPT Codes 9349-99350)

It is likely that expanded telemedicine / telehealth services are “here to stay” in one form or another, although it is not likely that ALL services approved to be delivered during the PHE will remain, particularly para-medical and in-patient hospital-based telemedicine services.

Where does that leave Oncology practices? Our belief is that the currently available codes under the PHE will remain at least until the end of CY 2021, if not beyond.

Now is the time to consider a “permanent” telemedicine solution that enables workflow, optimizes practice efficiency, provider and patient experience. We have identified the following important criteria when considering a telemedicine / telehealth solution:

1. Integration – In order to optimize practice efficiency, we strongly recommend the implementation of telemedicine solutions that are able to integrate with your practice management and scheduling systems. Without this level of integration there is likely dual entry of appointment schedules, manual calendar entries as well as in the practice scheduling system or other mechanisms to synchronize calendars.

2. Automated Reminders – No show rates for Telemedicine visits are higher than in person visits. The sending of automated reminders to patients – MULTIPLE TIMES – is imperative to minimizing no shows. Manual sending of reminders, on the other hand, is much less reliable.

3. Patients Preferred Language – not all patients are comfortable reading English. Any user interface provided to the patient should be provided to them in their preferred language as defined in your practice management system

4. Disconnect Management – Depending on the reliability of a patients internet connection it is likely that the patient will “vanish” mid-way through a telemedicine visit. The telemedicine platform must have a mechanism to allow the physician to continue visits with other patients, maximizing physician productivity AND automatically informing the patient if the physician wants them to reconnect, reschedule or otherwise.

5. Security – patients should not be permitted to click a permanent link and appear in a waiting room at their convenience. Links to visits should be specific to the patient, the visit and the appointment time frame.

6. Reports – Practices need reports on productivity, patient throughput, wait times, no show rates, late arrivals and more. Without these reports it is difficult to understand and improve workflows, productivity and patient satisfaction.

7. Patient Transfer – Teleconference and most telemedicine platforms allow “one patient one provider” virtual visits. The reality is that this approach is inefficient, adding additional data collection (or pre-visit screening) burden to the physician, reducing productivity.

If you have questions regarding CMS or the proposed changes for CY2021 please do not hesitate to reach out to us. Of course, if you’d like to discuss how to optimize your telemedicine productivity, patient satisfaction and workflows please do not hesitate to contact us at or complete the form here.

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