In the finalized 2020 Physician Fee Schedule, CMS is adding three CPT codes for telehealth services included in bundled episodes of care for opioid abuse treatment, including care delivered to the home.
The Centers for Medicare & Medicaid Services is moving forward with new reimbursement codes for care providers who use telehealth to treat patients dealing with opioid abuse.
As part of the 2020 Physician Fee Schedule, CMS is adding three CPT codes that will allow providers to bill Medicare for telehealth services included in bundled episodes of care for opioid abuse treatment, including care delivered to the home. The codes were first proposed in July as a means of applying connected health technology to the ongoing opioid abuse epidemic.
“We are announcing proposals so that the government doesn’t stand in the way of patient care, by giving clinicians the support they need to spend valuable time coordinating the care of these patients to ensure their diseases are well-managed and their quality of life is preserved,” CMS Administrator Seema Verma said in a July press release announcing the proposed codes.
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Now included in the recently announced final rule in a category titled Communication Technology-Based Services, the codes are:
HCPCS code G2086, covering at least 70 minutes during the first calendar month of office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling;
HCPCS code G2087, covering at least 60 minutes in a subsequent calendar month of office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; and.
HCPCS code G2088, covering each additional 30 minutes beyond the first two hours of office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling (filed alongside the code for a primary procedure).
According to an analysis of the new codes penned by Nathaniel Lacktman, a partner in the Foley & Lardner law firm and chair of its national Telemedicine & Digital Health Industry Team, and Emily Wein, a healthcare lawyer with the firm, the new codes combine with recent legislation to give opportunities new opportunities to deliver care to the patient’s home.
“CMS explained that, like certain other non- face-to-face services, the other components of HCPCS codes G2086-G2088 describing care coordination are commonly furnished remotely using telecommunications technology, and do not require the patient to be present in-person with the practitioner when they are furnished,” they wrote. “CMS also stated that by considering the face-to-face portion of HCPCS codes G2086-G2088 eligible for telehealth services, the originating site facility fee could be reported, consistent with all other rules, when these services are furnished via telehealth.”
“With respect to the originating site requirements, recall that the SUPPORT Act, effective as of July 1, 2019, statutorily removed the geographic limitations for telehealth services furnished to individuals diagnosed with a substance use disorder (SUD) for the purpose of treating the SUD or a co-occurring mental health disorder,” they added. “The change allows telehealth services for treatment of a diagnosed SUD or co-occurring mental health disorder to be furnished to individuals at any telehealth originating site (other than a renal dialysis facility), including in a patient’s home. No originating site facility fee is paid when the beneficiary’s home is the originating site.”
In addition to the new codes, CMS also clarified a potentially cumbersome requirement for patient consent. Under the final rule, care providers will only need to obtain one consent each year from the patient for multiple services or interprofessional consultations, rather than consent for each individual service. That consent must include the patient’s co-pay.
Source: mHealth Intelligence