Medicare proposes expanded coverage and payment for telemedicine

The proposed Medicare Physician Fee Schedule for 2014 includes two changes that impact telemedicine. The first would expand the geographic areas that are eligible for coverage. The second increases payment for care management services delivered via telemedicine. Expanded coverage In order to qualify for Medicare-covered telemedicine services, the beneficiary must be located in a rural area. Currently, Medicare defines rural as a non-Metropolitan Statistical Area (MSA) that is also located in an area that is designated as a Rural Health Professional Shortage Area (HPSA). The proposed rule would use the Office of Rural Health Policy’s (ORHP) method for defining a rural area. The ORHP’s method uses census data to determine rural areas, which in some cases includes areas located within an MSA. American Telemedicine Association (ATA) CEO Jonathan Linkous gave a reserved endorsement of the proposed rule in a press release. “Overall, the proposed rules are good news for Medicare patients and forward-thinking healthcare providers. We applaud CMS for taking steps to help these patients benefit from proven telemedicine technologies. But many potential beneficiaries are still left behind. For example, we hope that either CMS or Congress take additional steps to restore telehealth benefits to the one million beneficiaries in 104 counties that lost coverage last year due to reclassification to metropolitan areas.” Increased payments CMS also proposed adding two CPT codes used to report transitional care management services provided via telecommunication to high-risk patients following discharge (99495 and 99496) to its list of Category 1 telemedicine services. Addition to the Category 1 list means providers would receive reimbursement for the services, which CMS has determined to be similar to services offered face-to-face. According to the ATA, “Reimbursement of these services will help healthcare providers deliver improved in-home care to at-risk beneficiaries and significantly reduce needless hospital readmissions.”