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What's New in Medicare Reimbursement?

Telemedicine is slowly making progress in terms of more and more CPT codes for reimbursement being approved each cycle. For CY 2014 there are 2 new codes that have been added to the list of Medicare telehealth services! The first one is CPT code 99495 for Transitional Care Management Services. There are required elements including communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge, medical decision making of at least moderate complexity during the service period, and a face-to-face visit within 14 calendar days of discharge. The second related one is CPT code 99496 for Transitional Care Management Services. This one as required elements as well including communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge, medical decision making of high complexity during the service period, and a face-to-face visit within 7 calendar days of discharge. This policy basically allows the required face-to-face component of both services to be provided through telehealth! There are some other exciting things that are being finalized. First is the regulatory definition of “rural HPSA” for determining eligibility for Medicare telehealth originating sites. It will include HPSAs in rural census tracts (so it is consistent with rural as defined by ORHP). There is actually a useful tool that you can download that will help providers determine their geographic eligibility for Medicare telehealth services. It’s called the Medicare Telehealth Payment Eligibility Analyzer and can be found at http://datawarehouse.hrsa.gov/telehealthAdvisor/telehealthEligibility.aspx They are also finalizing a provision so that geographic eligibility for an originating site is established and maintained on an annual basis. This makes things consistent with other telehealth policies. So things are always looking better for telemedicine!

About the Author

Elizabeth Krupinski, Ph.D. is a Professor at Emory University in the Department of Radiology & Imaging Sciences and is Vice-chair of Research.. She is Associate Director of Evaluation for the Arizona Telemedicine Program and Director of the SWTRC. She has published extensively in these areas, and has presented at conferences nationally and internationally. She is Past Chair of the SPIE Medical Imaging Conference, Past President of the American Telemedicine Association, President of the Medical Image Perception Society, and Past Chair of the Society for Imaging Informatics in Medicine. She serves on a number of editorial boards for both radiology and telemedicine journals and is the Co-Editor of the Journal of Telemedicine & Telecare.

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