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CMS Telemedicine Coding Updates

In response to the national emergency that was declared concerning the COVID-19 outbreak, CMS has temporarily waived certain requirements related to telemedicine services.  The Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 now enables both patients and providers to conduct telehealth visits from home or offices.  CMS has also loosened regulations and will temporarily cover other types of telemedicine described below.

CBIZ has been monitoring the recently updated coding rules and guidelines implemented by CMS and has prepared a summary of the guidelines (as they currently stand) below.  Please note – the guidelines have been changing rapidly – even day to day. 


An Oversimplified Telemedicine Summary

LastUpdate: 05/12/2020, 11:00 AM

Telemedicine Summary update 5-12-20.png small-2.png

Note: All services above subject to specific documentation requirements


Medicare Telemedicine National Code Pricing Information

Last Update: 5/12/20, 11:00 AM

Telemedicine Summary Pricing updated 5-12-20.png small-2.png

Note: All services above subject to specific documentation requirements.  Pricing is 2020 Medicare National Price for Non-Facility Setting (i.e. Physician Office), updated for CMS-5531-IFC 


CMS has been continually updating the provider community on appropriate modifiers, place of service, and condition codes to be used to access telehealth, cost sharing, and other waiver provisions.  CBIZ stands ready to be a resource for compliant billing in this transitional period.  CBIZ can provide assistance with education and compliance to ensure that telemedicine codes are being applied properly.  If you have any questions, please contact Adam Abramowitz at aabramowitz@cbiz.com or at 609-220-5627.  


Resources: 

Press Release: Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge 

Fact Sheet: Additional Background:Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge 

Fact Sheet: Medicare Telemedicine Health Care Provider Fact Sheet 

Telemedicine Toolkit: General Provider Telehealth and Telemedicine Tool Kit Full List of CMS-Covered Telehealth Codes

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