Wiki TELEMED

[syprice]

I have a provider that wants to bill a telemed for a new patient. Does anyone know if this is acceptable? I thought they had to be an established patient.
Appreciate any feedback. Thanks

 

[csperoni]

My understanding is post PHE, audio/video telehealth is still permitted. AUDIO only must be established patients.
At least those are the Medicare guidelines (for now). Commercial payors could vary and you would need to check with the carrier.

https://namas.co/telehealth-checklist/

https://namas.co/the-phe-ends-may-11th-what-ends-what-was-extended-and-what-is-permanent/

 

[jkyles]

Just adding that I also thought telephone E/M visits (99441-99443) reverted to established patient only after the PHE. But I can't find anything from Medicare that says they have revoked the waiver that allows it for new patients. By comparison, Medicare clearly states that it eliminated the waiver that allowed remote monitoring for new patients.

 

[csperoni]

Just adding that I also thought telephone E/M visits (99441-99443) reverted to established patient only after the PHE. But I can't find anything from Medicare that says they have revoked the waiver that allows it for new patients. By comparison, Medicare clearly states that it eliminated the waiver that allowed remote monitoring for new patients.

I provided the NAMAS links, but I do agree that from CMS directly is the best reference. NAMAS is a reputable company in my opinion, but anyone can make an error. I was able to find this from CMS regarding post PHE which was updated 7/20/2023. Specifically at the bottom of page 8:
When clinicians have furnished an evaluation and management (E/M) service that otherwise would have been reported as an in-person or telehealth visit, using audio-only technology, practitioners have been able to bill using these telephone E/M codes provided that it is appropriate to furnish the service using audio-only technology and all of the required elements in the applicable telephone E/M code (99441-99443) description are met.

Since the descriptor of 99441-99443 states established patient, I interpret a new patient would not meet "all of the required elements".

 

[jkyles]

I provided the NAMAS links, but I do agree that from CMS directly is the best reference. NAMAS is a reputable company in my opinion, but anyone can make an error. I was able to find this from CMS regarding post PHE which was updated 7/20/2023. Specifically at the bottom of page 8:
When clinicians have furnished an evaluation and management (E/M) service that otherwise would have been reported as an in-person or telehealth visit, using audio-only technology, practitioners have been able to bill using these telephone E/M codes provided that it is appropriate to furnish the service using audio-only technology and all of the required elements in the applicable telephone E/M code (99441-99443) description are met.

Since the descriptor of 99441-99443 states established patient, I interpret a new patient would not meet "all of the required elements".

Right, it's just one of those things where if someone were to ask me "Where does CMS say stop reporting this for new patients?" I couldn't point to anything right now. The fact that CMS was specific for some other services (in that document and the 2024 proposed rule) makes it worse.

However, the lack of clarity creates risk for people who continue to report the services for new patients. Maybe it was an oversight! I think people should check with their MAC to figure out what's going on. But sudden denials for new patients would be a big hint.