August Update: Read about the 2021 Proposed Medicare Physician Fee Schedule in our post summarizing proposed changes to Digital Health and Remote Patient Monitoring and our post about changes to Telehealth.

Update: Head to our resource page “Responding to COVID-19: Resources for Telehealth and Remote Patient Monitoring”

This post is the second in a series of posts about the Final 2020 MPFS. To read our previous post, click here!

The Centers for Medicare and Medicaid Services (CMS) released the Final Medicare Physician Fee Schedule for CY 2020 (the “2020 MPFS”) on November 1, 2019. The 2020 MPFS finalizes six new CPT codes for e-Visits, providing new opportunities for physician practices to be reimbursed for conducting digital health assessments and evaluations for their patients and for remote patient monitoring companies to add these capabilities to their platforms. However, the final 2020 MPFS also leaves several questions about these new codes unanswered. This post summarizes how healthcare practitioners can get paid for conducting e-Visits via the new codes and describes the outstanding questions that remain.

What are the new e-Visit CPT codes? 

The final code descriptors for the new e-visit codes are as follows:

HCPCS code G2061: Qualified nonphysician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes

HCPCS code G2062: Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes

HCPCS code G2063: Qualified nonphysician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes

CPT code 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

CPT code 99422: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes 

CPT code 99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

What you need to know about the new e-Visit codes  

Commenters to the proposed 2020 MPFS asked CMS to provide examples of specific use cases and additional detail regarding use of the e-Visit codes. Unfortunately, CMS did not address these comments in the final rule. For now, here is what we know: 

What is an e-Visit?

The 2020 MPFS describes e-Visits as non-face-to-face “patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.” The descriptors further suggest that the codes are intended to cover short-term (“up to seven days”) evaluations and assessments that are conducted online or via some other digital platform, and likely also include any associated interpretation and clinical decision making. Evaluations and assessments that extend beyond the seven-day maximum may constitute remote patient monitoring.

Who can bill for the e-Visit codes? 

CPT codes 99421-99423 are reserved for physicians and other healthcare practitioners that can directly bill Medicare E/M codes. Acknowledging that there are non-physician healthcare practitioners who are unable to bill Medicare but that will likely perform these e-Visits, CMS created HCPCS codes G2061, G2062, and G2063 for non-physician practitioners who are unable to bill E/M services. CMS specifically stated in the rule that audiologists and speech language pathologists are ineligible to bill for HCPCS codes G2061-G2063 because the codes fall outside their benefit category.

What is an “established patient”?

The 2020 MPFS states that in order to bill for an e-Visit, a patient must be “established” — meaning the provider must have an existing provider-patient relationship with the patient. Whether a patient is “established” is usually determined under state law and typically requires a full examination of the patient’s current condition(s) and medical history.

What questions about e-Visits are still outstanding?

Commenters to the 2020 proposed rule urged CMS to remove the “patient-initiated” requirement, highlighting use-cases in which provider-initiated evaluations and assessments could help patients avoid unnecessary office and emergency room visits. Commenters also asked CMS to provide specific examples of use cases that demonstrate clinical decisions that “otherwise typically would have been provided in the office,” demonstrating a concern that the language is ambiguous and may serve as a barrier to adoption. CMS did not address these comments in the final rule, leaving these questions unanswered.

Nixon Law Group will be engaging with stakeholders on these outstanding questions, and we are monitoring developments in this space closely. Interested in how to implement e-visits with your patients or add new functionality to your remote patient monitoring software? Contact us!

For more information about the 2020 MPFS, read our previous post

Discover how we can help you optimize innovative payment models