ACEP’s Telehealth Advocacy During COVID-19 Pandemic

Last week, the Centers for Medicare & Medicaid Services (CMS) announced major temporary expansions to existing telehealth policies under Medicare in an effort to enable patients to communicate with their doctors remotely during this national emergency.

From the moment CMS put out this guidance, many of you have reached out with questions about what this means for emergency physicians and emergency medicine more generally. ACEP staff have been in constant contact with CMS to try to answer your questions and resolve outstanding issues. Here is an overview of what we know and what we are continuing to work out with CMS.

What we know

Although providing emergency telehealth services during a federal emergency is critical, it was unclear at first from CMS’ guidance whether emergency physicians could in fact deliver telehealth services. After extensive outreach to CMS, we were able to receive this official guidance:

Medicare and Medicaid are covering emergency telehealth services.

Reimbursement of telehealth in Medicaid varies by state.

For Medicare:

• Emergency physicians can perform telehealth services from any location, including the emergency department (ED).
• You can bill office/outpatient evaluation and management services (E/M) services (CPT codes 99201-99215) or any other code on the list of approved Medicare telehealth services. Some of the other codes on the list that are commonly billed include: psychiatric diagnostic evaluations (CPT codes 90791-90792), psychotherapy for crisis (CPT codes 90839-90840) and critical care consult G-codes (HCPCS codes G0508-G0509).
• ED E/M codes (CPT codes 99281-99285) are NOT on the list of approved Medicare telehealth services and therefore cannot be used. More on this below!
• The place of service code for telehealth services is "02," which means the ED setting (POS 23) wouldn't be submitted on the claim.

What we are still waiting on

One common question we’ve received is whether the medical screening exam (MSE), which is a requirement under Emergency Medical Treatment and Labor Act (EMTALA), can be performed via telehealth.

The answer right at this very moment is “no.” However, CMS is working on revising EMTALA guidance to allow MSEs to be delivered via telehealth. We have been actively working with CMS on this guidance and believe that it will be released soon.

In our communications with CMS, we have emphasized how critical this EMTALA guidance is. For example, earlier this week, a member of ACEP’s Board of Directors, Dr. Alison Haddock, raised the issue on a call with the CMS Administrator, Seema Verma, on Tuesday. Dr. Haddock told Administrator Verma directly that this guidance would help protect emergency physicians from unnecessary exposure to the virus and help preserve our limited supply of personal protective equipment.

Lastly, we have heard that many of you would like to use the traditional ED E/M codes when delivering emergency telehealth services—as these codes better reflect the intensity of emergency services than the office and outpatient E/M codes do. Please know that we are actively pushing CMS to add these codes to the list of approved Medicare telehealth services. CMS is working on a COVID-19 regulation now that should be released by the end of the week, and CMS may address this issue in that reg.

We will keep you updated as CMS continues to revise its telehealth-related guidance. We also recognize you have questions on other issues besides telehealth. CMS and other federal agencies are constantly putting out new guidance in response to the COVID-19 pandemic. We are reviewing guidance as it comes out and posting key information on our website.

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!

Unfortunately, the Regs & Eggs podcast has been indefinitely suspended during the COVID-19 pandemic.