CMS expands telehealth, additional waivers and new rules to address COVID-19

On March 30th, as part of the ongoing effort to address the COVID-19 public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) issued several additional temporary regulatory waivers and new rules for physicians and other clinicians. At the same time, CMS also released an Interim Final Rule with comment period outlining further changes for Medicare and Medicaid programs. The changes are effective immediately for the duration of the emergency declaration. 

Under the new flexibilities, CMS will allow telehealth to fulfill many face-to-face visit requirements for more than 80 additional services, including use of audio only phones to ensure patients have access to physicians and other clinicians while safe at home.  In order for the health care system to rapidly expand its workforce, CMS removed barriers for physicians, nurses, and other clinicians to be readily hired from the community or from other states. CMS also expanded in-place testing to allow for more testing at home or in community based settings. Local hospitals and health systems now have the capacity to handle a potential surge of COVID-19 patients through temporary expansion sites (also known as CMS Hospital Without Walls). In addition, CMS will provide temporary relief from many paperwork, reporting and audit requirements so providers, health care facilities, Medicare Advantage and Part D plans, and States can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.

CMS temporary new rules include, but are not limited to, the following services:

• Use of audio only phones (CPT codes 98966 -98968; 99441-99443)
• Emergency Department Visits, Levels 1-5 (CPT codes 99281-99285)
• Initial and Subsequent Observation and Observation Discharge Day Management (CPT codes 99217- 99220; CPT codes 99224- 99226; CPT codes 99234- 99236)
• Initial hospital care and hospital discharge day management (CPT codes 99221-99223; CPT codes 99238- 99239)
• Initial nursing facility visits, All levels (Low, Moderate, and High Complexity) and nursing facility discharge day management (CPT codes 99304-99306; CPT codes 99315-99316)
• Critical Care Services (CPT codes 99291-99292)
• Domiciliary, Rest Home, or Custodial Care services, New and Established patients (CPT codes 99327- 99328; CPT codes 99334-99337)
• Home Visits, New and Established Patient, All levels (CPT codes 99341- 99345; CPT codes 99347- 99350)
• Inpatient Neonatal and Pediatric Critical Care, Initial and Subsequent (CPT codes 99468- 99473; CPT codes 99475- 99476)
• Initial and Continuing Intensive Care Services (CPT code 99477- 994780)
• Care Planning for Patients with Cognitive Impairment (CPT code 99483)
• Psychological and Neuropsychological Testing (CPT codes 96130- 96133; CPT codes 96136- 96139)
• Therapy Services, Physical and Occupational Therapy, All levels (CPT codes 97161- 97168; CPT codes 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507)
• Radiation Treatment Management Services (CPT codes 77427)

For more information on the COVID-19 waivers and Interim Final Rule changes, please visit the CMS COVID-19 flexibilities webpage. A complete list of CMS covered telehealth services can also be found on the CMS site.