{"id":26729,"date":"2020-03-23T13:19:34","date_gmt":"2020-03-23T13:19:34","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=26729"},"modified":"2020-03-23T13:19:34","modified_gmt":"2020-03-23T13:19:34","slug":"furnishing-and-billing-e-visits-addressing-your-questions","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/furnishing-and-billing-e-visits-addressing-your-questions\/","title":{"rendered":"Furnishing and Billing E-Visits: Addressing Your Questions"},"content":{"rendered":"\n

Recent waivers by CMS that allow for limited digital communication with patients have triggered a wave of questions. Here are our answers to the ones we hear most often.<\/h2>\n\n\n\n

APTA is receiving many questions about the recent regulatory waivers announced by CMS related to digital communication between providers and patients, particularly regarding e-visits and the use of HCPCS codes G2061-G2063. We’ve compiled this list of the most common questions we’ve received so far.<\/p>\n\n\n\n

Please note that e-visits are NOT the same as telehealth or telerehab services. Congress and CMS have not modified Medicare to allow physical therapists to the roster of providers who can be reimbursed for telehealth services. With that said, APTA regulatory and payment staff are working directly with CMS and private payers to seek expansion of coverage of telehealth services to include physical therapy services.<\/p>\n\n\n\n

Also important to keep in mind: If you don\u2019t find the answer to your question here, continue to consult trusted sources such as APTA (advocacy@apta.org<\/a>). Avoid acting on conjecture or recommendations that you don\u2019t know to be reliable.<\/p>\n\n\n\n

In addition the information here, CMS also has answers to Frequently Asked Questions<\/a> about e-visits. You can find reimbursement rates for the e-visit related codes using the CMS Physician Fee Schedule Look-Up Tool<\/a>.<\/p>\n\n\n\n

APTA offers recordings of two recent online presentations on e-visits: an online town hall presentation <\/a>from March 19 as well as a March 20 Facebook Live event<\/a>.<\/p>\n\n\n\n

[Editor’s note: The parenthetical dates at the end of each answer indicate either the date it was created or the last time it was updated.]<\/em><\/p>\n\n\n\n

In General<\/h2>\n\n\n\n

1. What is an e-visit?<\/strong>
In its 2020 physician fee schedule final rule<\/a>, CMS describes e-visits as \u201cnon face-to-face patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.\u201d The code descriptors for the HCPSC codes related to e-visits suggest that the codes are intended to cover short-term (up to seven days) assessments and management activities that are conducted online or via some other digital platform and include any associated clinical decision-making. (March 18)<\/p>\n\n\n\n

2. Is an e-visit a telehealth service?<\/strong>
No. An e-visit is considered a service furnished remotely using technology but is not considered a Medicare telehealth service. Under Medicare physical therapists are still not recognized as telehealth providers. An e-visit does not constitute telehealth under the Medicare definition. Under commercial payer policies, the answer varies, so check with your payer. (March 20)<\/p>\n\n\n\n

3. Are PTs required to complete an 1135 waiver to bill for an e-visit?<\/strong>
No, it’s a blanket waiver. But you must use the CR modifier. See question 15 below. (March 20)<\/p>\n\n\n\n

4. What is an online patient portal?<\/strong>
The HHS Office of National Coordinator for Health Information Technology (ONC) describes a patient portal<\/a> as a secure online website that gives patients convenient, 24-hour access to personal health information from anywhere with an internet connection. A patient portal requires a secure username and password to allow patients to securely message their provider. (March 18)<\/p>\n\n\n\n

5. Is an online patient portal the only medium PTs can use for an e-visit? Can a phone call encounter without video qualify?<\/strong>
Under the original code description, an online patient portal is required. Although CMS has implied that they are giving providers flexibility in the platform used, please check with your Medicare Administrative Contractor (MAC) for guidance. (Revised March 20)<\/p>\n\n\n\n

6. Is there a way for a PT to establish a new patient using an e-visit, for patients who do not want to come in person for an evaluation? Similarly, can a physician transfer a new patient or establish a new patient under a PT\u2019s care in order for the PT to use the e-visit codes for an evaluation?<\/strong>
No. The patient must already be under the care of the therapist. Check your state practice act for additional guidance on what is considered an \u201cestablished patient.\u201d (March 20)<\/p>\n\n\n\n

7. How does the assessment work? Are G2061, G2062, and G2063 the codes to use?<\/strong>
The assessment and management codes G2061-G2063 allow a provider to respond to a patient-initiated request for an e-visit. The term is misleading, as this is not a \u201cvisit\u201d in the traditional sense but rather activities and correspondence that support a patient over a maximum of a seven-day period. (March 20)<\/p>\n\n\n\n

8. CMS originally said there would be leniency with providing e-visits across state lines. Does this hold true for other insurances?<\/strong>
The 1135 provisions include a “waiver of provider licensure,” but it doesn’t mean much unless a state creates a waiver, too. The 1135 system wasn’t created solely for pandemics \u2014 it’s also used to respond to regional disasters, where out-of-state providers may be needed to respond to an emergency. That’s where the licensure waiver has the most effect. While the provisions do include a waiver that allows authorized providers to render services outside their states of Medicare enrollment, in order for the provider license waiver to be of practical use, states need to create their own licensure waivers because state requirements take precedence. However, many states are passing legislation related to licensure requirements. (March 20)<\/p>\n\n\n\n

Coding and Billing<\/h2>\n\n\n\n

9. What codes can a physical therapist bill for an e-visit?<\/strong>
Physical therapists are eligible to use these HCPSC codes:<\/p>\n\n\n\n