Level Selection for Office/Outpatient E/M Visits When Furnished Via Medicare Telehealth

By Baker Newman Noyes April 6, 2020

Current information as of March 30, 2020

During the public health emergency (PHE) for the COVID-19 pandemic, on an interim basis, the Centers for Medicare and Medicaid Services (CMS) has revised their policy so that office and outpatient evaluation and management (E/M) services (99201-99215) provided via telehealth (real time, interactive audio/visual) can be based on medical decision making (MDM) or time.

Interim guidelines

• Time is defined as all of the time associated with the E/M on the day of the encounter
  • Does not need to be dominated by counseling services
  • Use typical times listed in the Current Procedural Terminology (CPT) Manual
  • Use only the total time that the practitioner spends on the service
• Requirements of history and/or physical exam is removed
• Document E/M visits as necessary to ensure quality and continuity of care
• Current definition of MDM remains as currently defined

This policy CMS-1744-IFC 137 only applies to office/outpatient visits furnished via Medicare telehealth, and only during the PHE for the COVID-19 pandemic.

Regardless of the service provided, documentation and compliance for each service is an important reminder. Things to consider:

• Consent to treat
• Health Insurance Portability and Accountability Act (HIPAA) rules/regulations
• Documentation requirements, including but not limited to medical necessity, history and exam (if applicable), MDM, and/or time
• Monitoring of services provided prior to and/or following virtual visits (bundling of services)
• Document where the provider and patient are located, include circumstance for type of service

For more information, contact your BNN healthcare advisor at 800.244.7444.