This update revisits two issues we have written about before: tele health waivers and recent changes to the COVID-19 testing and diagnosis requirements.

Tele Health Status

The CMS has released updated schedules for 2021 and nine of the temporary tele health codes have been made permanent (category 1) and thirteen codes (category 3) have been extended and will terminate at the end of year that the Public Health Emergency ends.  Currently the PHE extends until 23 Oct 2020, however, it's widely expected to be extended until January, 2021. Category 3 codes would thus extend until December 31, 2021. Seventy-four codes (category 2) will terminate when the PHE is over.

This unique approach keeps the codes with proven efficacy, while allowing time to gather real data and feedback on others that show promise.  In line with the CMS objective to develop a long-term tele health strategy, pubic feedback is being solicited here: https://beta.regulations.gov

‍

Summary of Tele Health Codes

Category 1 (codes expected to be made permanent in January 2021)

• Group Psychotherapy | 90853
• Domiciliary, Rest, Custodial Care– established patients | 99334-99335
• Home Visits, Established Patient (15, 25, 40 mins) | 99347-99348
• Cognitive Assessment and Care Planning | 99483
• Visit Complexity Inherent in Office/OP E/M | GPC1X
• Prolonged Services | 99XXX
• Psychological and Neuropsychological Testing | 96121

Category 3 (temporary codes extend  through calendar year in which the PHE ends)

• Domiciliary, Rest, Custodial Care– established patients | 99336-99337
  (Level of complexity level 4, 5, 6 and 7;15, 25, 40, and 60 min)
• Home Visits, Established Patient | 99349-99350
  (Level of complexity; 50 and 60 min)
• Emergency Visits – Levels 1-3 | 99281-99283
  (Level 1 99281: limited; level 2-moderate,  level 3 moderate/severe)
• Nursing facilities discharge day management | 99315-99316
• Psychological and Neuropsychological Testing | 99130-96133
  (96130 is psychological testing first hour, 93161 each addtl hour; and so on)

Category 2: For Reference (codes set to terminate when PHE ends)

99304-99306, 96136-99139, 97161-97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507, 99221-99223, 99238- 99239, 99468- 99472, 99475- 99476, 99477-99480, 99291-99292, 90952-90953, 90956, 90959, 90962 , 77427, 99284-99285, 99324-99328, 99341- 99345, 99217-99220, 99224- 99226, 99234-99236

Note: Most insurance companies follow CMS guidelines, however, some will provide their own guidelines.

COVID testing / Reduction in MS-DRG weighting factor

The CARES act allowed providers to add an additional 20% to claims when COVID-19 was present.   Specifically, the code U07.1 (COVID-19) was required for discharges occurring on or after April 1, 2020, through the duration of the COVID-19 public health emergency period, currently scheduled to end on 23 Oct 2020.  However, a positive test result was not required in order for the U07.1 code to be assigned.  Effective Sep 1, a positive viral laboratory test must be present in the patient records in order for the 20% claims weighting to be applied.