Telemedicine Advances in CMS Proposed CY 2019 Physician Fee Schedule

The Centers for Medicare and Medicaid Services recently published its annual proposal for the CY 2019 Physician Fee Schedule. In this document, they include all changes proposed to reimbursement policy. This year has seen considerable positive changes to their telehealth policies and billable services and corresponding CPT codes. They have included coverage for “brief, communication technology-based services,” evaluation of remote patient monitoring data, consultations between physicians via the internet, and added new codes for chronic care management, general telemedicine and remote patient monitoring. Also included are the changes required by the Bipartisan Budget Act of 2018 for End-Stage Renal Disease telehealth management and telestroke care, as well as a new bundled code set for Substance Use Disorder and Medication Assisted Therapy that includes web-based services.

For providers who work with Medicare, these changes obviously have great meaning for the future of telemedicine reimbursement, but even those who don’t work with Medicare have reason to be excited. CMS often sets the tone for state medicaid programs and military health care, and is used as an indication of the “minimum level required to be covered” for most commercial insurance companies. The more advances and forward momentum CMS gains, the brighter the future will be for telemedicine reimbursement in our country as a whole.

For those who wish to share their thoughts and ideas, the comment period closes by September 5, 2018, and the finalized version should be released sometime in November of 2018.

The Center for Connected Health Policy published a helpful fact sheet and infograph to increase understanding of and clarify these proposed changes.  To view the full text of the proposed rule click here.