Expansion of Eligible Telehealth PHE Codes & Resources for CHIP & Medicaid

Expansion of Eligible Telehealth PHE Codes & Resources for CHIP & Medicaid

Yesterday the Centers for Medicare and Medicaid Services (CMS) announced the expansion of the list of telehealth services that are eligible for reimbursement during the Public Health Emergency (PHE).  Prior to the coronavirus PHE, CMS allowed for reimbursement of approximately 100 codes via telehealth when certain conditions were met.  During the first three months of the PHE, that list was expanded to include 238 service codes.  The latest expansion adds 11 new codes to the list including:

  • 95970-95972, 95983, 95984 – Electronic analysis of implanted neurostimulator pulse generator/transmitter
  • 93797, 93798, G0422-G0423 – Intensive cardiac rehabilitation
  • 93750 – Interrogation of ventricular assist device (VAD)

CMS simultaneously also released a supplement to its State Medicaid and CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 version to include an updated supplemental document that contains an updated list of frequently asked questions (FAQs), as well as several other tools for state Medicaid programs (e.g. telehealth assessment and action plan template).  The supplement also includes profiles of five states (CO, ID, ME, MA and WI) telehealth policy responses to the COVID-19 emergency. State interviewees for the profiles reported telehealth benefits included reduced no-show rates, decreased non-emergency transportation costs, the ability to engage populations that historically are difficult to access and greater access for beneficiaries with limited time off work or with childcare concerns.  Additionally, audio-only visits were reported to be an important factor in the success of telehealth during the PHE, especially for beneficiaries in rural and frontier areas with limited broadband access.  For more information on all the resources CMS has developed and to read the full state profiles, see the full supplemental document.

Finally, in the same announcement, CMS also released a first-ever snapshot on telehealth utilization in Medicaid and CHIP during the PHE.  Preliminary data from the snapshot slides reveal the following:

  • Services delivered via telehealth increased from February through April 2020.
  • Telehealth delivered services were highest among working age adults, followed by children and older adults.
  • Among both children and adults, services delivered via telehealth per 1,000 beneficiary months from March through June 2020 varied across states.
  • Services delivered via telehealth (paid by Medicaid) per 1,000 beneficiary months from March through June 2020 was lowest among beneficiaries age 65+ across most states.

See the full snapshot for additional information on Medicaid and CHIP utilization during the PHE.

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