The updates below are current as of March 18, 2020.
With the coronavirus pandemic affecting nearly every aspect of our lives, physical therapists are also feeling the pinch with cancellations and a high volume of calls from concerned patients. Everyone must do their part to help reduce the risk of spreading COVID-19; as health care providers, physical therapists will serve an important function through this crisis.
There is a genuine rush to help stop the spread of this virus. That means regulations may continue to be modified or change at a moment’s notice. We will try to keep everyone updated as we learn of upcoming notices.
Many physical therapists are wondering about telehealth as a potential approach. The Health Resources Services Administration (HRSA) defines telehealth as the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Different telehealth modalities include live video, mobile health, remote patient monitoring and store and forward technologies. However, telehealth is not just a quick audio or video chat. The level of care must be similar to or the same as in-office care.
Historically, physical therapists have not been statutorily authorized Medicare providers of telehealth. In other words, physical therapy services delivered through telehealth are not payable under the physician fee schedule. Because of the unprecedented coronavirus pandemic, therapists were hopeful that physical therapy was going to be added to the list of approved Medicare telehealth services.
Unfortunately, that didn’t happen based on the details that were released from CMS on March 17, 2020. When this announcement came down, therapists were still not added to the group that can bill Medicare patients for telehealth. Is there a chance that this will change in a future announcement? Only time will tell.
When it comes to telehealth coverage for commercial payers, that still remains a per contract and per policy regulation. You should reach out to your commercial payers to determine if they will reimburse telehealth services under your contract. If they state that they do cover telehealth services, it is also important to verify the specific CPT codes that they will accept. Additionally, we also encourage that you verify the telehealth coverage based on the patient’s specific policy.
Some states have parity laws that pertain to telehealth, which require commercial payers to reimburse live telehealth at the same rates that they would reimburse in-person care.
When it comes to billing telehealth, many commercial payers require claims to be submitted with place of service 02 and with a GT modifier. However, the payers appear to be giving mixed messages on the modifier requirements at this time. Our team is continuing to review the telehealth claim requirements for each payer and update our payer rules engine for each payer as these details are confirmed.
Due to COVID-19, the topic of E-visits has been bantered around lately. While some therapists were hoping this may be the saving grace during this time, it doesn’t appear that will happen due to the visit limitations and lower reimbursement for the allowed codes (G2061-G2063). The CMS announcement stated that E-visits must be completed via an online patient portal; please keep in mind that it is still unclear as to what CMS means and hopefully they will better define it in the days ahead.
It is important to note that the patient MUST generate the initial inquiry and must have already had an evaluation in the office. The G-codes can only be billed once every seven days and the top tier code (G2063) reimburses approx. $34 to $37 depending on your locality. We have included a list of the available E-visit codes and descriptions below for easy reference.
G2061 – Medicare Allowable approximately $13. (depending on your location)
Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes
G2062 – Medicare Allowable approximately $23. (depending on your location)
Qualified nonphysician healthcare professional online assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes
G2063 – Medicare Allowable approximately $34. (depending on your location)
Qualified non-physician qualified healthcare professional assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes
Here is the full article from the APTA regarding E-visits: https://bit.ly/2UmGdgi
With the unprecedented state of affairs, regulations may change by the time you read this if the pandemic continues to escalate. We also want to remind therapists that Medicare does allow physical therapists to treat patients in their home under Medicare Part B as long as the patient is homebound (although the patient doesn’t necessarily have to be confined to their bed). Also, it’s important to confirm that the therapist is correctly credentialed with CMS to treat patients in the home.
It’s understandable that some elderly patients may be too afraid to come into an office environment or leave their own homes during this outbreak. If the therapist feels comfortable enough to go to the patient’s home, it is allowed and can help supplement an otherwise canceled visit. This may not be for everyone, but it is an option that’s available to therapists.
We certainly live in extraordinary times, and they will undoubtedly become more complex and confusing with every passing day. If you have further questions, feel free to reach out to us and we’ll be with you every step of the way – through this crisis – and beyond.