CMS Drops 2019 Telehealth Fact Sheet for Medicare

The Center for Medicare & Medicaid Services (CMS) recently released its 2019 Medicare Fact Sheet for Telehealth Services which outlines what services the program will reimburse if delivered via telehealth.  The 2019 Fact Sheet outlines the changes that were made by two pieces of legislation passed in 2018, the Bipartisan Budget Act of 2018 (BBA) and the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (Support Act).  Both Acts expanded where services delivered via telehealth could take place.

Prior to the passage of the two Acts, originating sites (where the patient is located) included:

  • Physician and practitioner offices
  • Hospitals
  • Critical Access Hospitals (CAHs)
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Hospital-based or CAH-based Renal Dialysis Centers (including satellites)
  • Skilled Nursing Facilities
  • Community Mental Health Centers
  • Renal Dialysis Facilities

The originating site also had to be geographically located in a county outside of a Metropolitan Statistical Area or in a rural Health Professional Shortage Area in a rural census tract.

The BBA expanded originating site locations for Medicare enrollees receiving services for End-Stage Renal Disease (ESRD) and acute stroke.  Specifically, the home will be an eligible originating site when practitioners furnish monthly home dialysis ESRD-related Medical evaluations.  Additionally, the geographic limitation on originating sites would not apply to hospital-based and CAH-based renal dialysis centers, renal dialysis facilities, and the beneficiary homes when they are receiving those ESRD services.

The BBA also removed the originating site geographic limitation when diagnosing, evaluating or treating symptoms of acute stroke.  Mobile stroke units were also added as eligible originating sites.  This means that when treating for acute stroke, the geographic limitation will not apply to all eligible originating sites whereas, in the case of ESRD services, only some sites have the geographic limitation removed.  However, there is a new modifier that will need to be used for these telestroke services which is detailed in this fact sheet by CMS.

Beginning July 1, 2019, the SUPPORT Act will add the enrollee’s home as an eligible originating site and remove the originating site geographic limitation on existing eligible telehealth originating sites (including the home) when treating for a substance use disorder or co-occurring mental health disorder through telehealth.

Additionally, CMS will reimburse for G0513 and G0514, prolonged preventive services, when provided via telehealth.

For more information download a copy of the
CMS Telehealth Fact Sheet