CMS Expanding Telehealth During the COVID-19 Pandemic

The health care law attorneys at Chapman Law Group discuss compliance and regulatory matters health care practitioners should know in the wake of the Coronavirus.

In the midst of what is normally cold, flu and allergy season, the U.S. is contending with the Coronavirus (COVID-19) pandemic — and health care providers have been feeling its rocky effects.

More people are turning to emergency rooms and hospitals, while fewer are going to their primary care physician or other doctors’ appointments. Meanwhile, physicians, nurses and other practitioners are in the direct line of Coronavirus exposure from patients. Because of this, practitioners are turning to telehealth and telemedicine services, which is becoming a safer service provision option for their patients — and themselves.

Fortunately, the Centers for Medicare and Medicaid services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can still receive treatment from their physician without having to travel to a health care facility. This is a temporary expansion of this CMS benefit that has been passed under the 1135 Waiver and the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020.

In-Home Care and Reduced/Waived Funds Owed

Starting March 6, 2020, Medicare will pay for office, hospital and other visits furnished via telehealth across the U.S., including in the patient’s place of residence. The new provision allows doctors, nurse practitioners, clinical psychologists and licensed clinical social workers to provide in-home care for these patient services.

Previously, the telehealth benefit was strictly limited to patients who lived in rural areas and had to travel to a local medical facility to get telehealth services from a doctor in a remote location. These patients would not be allowed to receive services in their home.

Additionally, on March 17, 2020, the OIG published a policy statement for physicians and other practitioners. It will reduce or waive amounts owed by federal health care program beneficiaries for telehealth services during the Coronavirus outbreak. Under this new policy, physicians and practitioners will not be subject to administrative sanctions and other regulatory requirement related to reducing or waiving any cost-sharing obligations (such as patient co-pays) that federal health care program beneficiaries may owe for telehealth services. It is important to note, however, that these services still must be furnished consistent with the appliable coverage and payment rules.

How Each Telehealth Service Differs

There are three types of virtual, telehealth services that physicians and other professionals can provide to Medicare beneficiaries, each of which have different requirements:

Medicare telehealth visit

Provider must use interactive audio and video with real-time communication with the patient, and patients must have a prior established relationship with that particular provider. CMS also stated on its provider fact sheet that, “to the extent the waiver requires that the patient have a prior established relationship with a particular practitioner,” the U.S. Department of Health and Human Services (DHHS) “will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.” The codes are:

  • 99201-99215: Office or other outpatient visits
  • G0425-G0427: Telehealth consultation, emergency department or initial patient
  • G0406-G0408: Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or skilled nursing facilities

Virtual check-ins

Brief communication service with practitioners via telephone or video and image initiated by the patient. The patient must have prior established relationship with that particular provider and must verbally consent to receive virtual check-in services. Medicare coinsurance and deductible would generally apply to these services. The codes are:

  • HCPCS G2012: Telephone communication
  • HCPCS G2010: Video or Image communication


Non-face-to-face, patient-initiated online evaluation and management conducted via a patient portal. Communication can occur over a seven-day period. Codes are:

  • 99421: Online digital evaluation and management, 5-10 minutes cumulative over seven days
  • 99422: Online digital evaluation and management, 11-20 minutes cumulative over seven days
  • 99423: Online digital evaluation and management, 21 or more minutes cumulative over seven days
  • G2061: Qualified non-physician health care professional online assessment and management, 5-10 minutes over seven days
  • G2062: Qualified non-physician health care professional online assessment and management, 11-20 minutes over seven days
  • G2063: Qualified non-physician health care professional online assessment and management, 21 or more minutes over seven days

How HIPAA Factors Into This

HIPAA compliance must be considered when conducting telehealth visits with patients. If possible, communication should be conducted through secure portals.

However, because COVID-19 has become a public health emergency, the DHHS Office for Civil Rights will be using discretion when exercising enforcement. The Office will be waiving penalties for HIPAA violations against health care providers that are serving patients through everyday communication technologies — such as Skype and FaceTime — but this waiver will only apply to communication during this emergency.

As your practice sees more activity during the Coronavirus pandemic, our compliance practice attorneys at Chapman Law Group want to make sure you understand and are following these new telehealth policies and related changes. Contact us today so we may review these guidelines with you.

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Juan C. Santos, LL.M.

Senior Attorney

Healthcare Compliance, Healthcare Fraud Defense

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701 Waterford Way, Suite 340
Miami, FL 33126
Phone: (305) 712-7177

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