For the first time, nephrology practices can use telehealth devices to conduct visits with patients on dialysis who are treated at outpatient clinics. Previously, federal regulations only allowed such services to be used for patients on home dialysis.
The decision by the agency released on March 17 is part of an effort to limit the risks of spreading COVID-19. The regulations also apply to visits with patients who have chronic kidney disease but are not on dialysis. Practices will be able to bill for the same monthly capitated payments for the visits, but the nephrologist must make a live once-a-month visit with the patient in the dialysis clinic or in an office setting.
CMS said it is expanding the telehealth benefit “on a temporary and emergency basis” under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.
“The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19 – are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus,” CMS said in a statement. “ ... [W]ith the emergence of the virus causing the disease COVID-19, there is an urgency to expand the use of technology to help people who need routine care, and keep vulnerable beneficiaries and beneficiaries with mild symptoms in their homes while maintaining access to the care they need. Limiting community spread of the virus, as well as limiting the exposure to other patients and staff members will slow viral spread.”
According to CMS, under the 1135 waiver, Medicare can pay for office, hospital and other visits furnished via telehealth across the country and including in patients’ places of residence.
“A range of providers, such as doctors, nurse practitioners, clinical psychologists and licensed clinical social workers, will be able to offer telehealth to their patients. Additionally, the HHS OIG is providing flexibility for health care providers to reduce or waive cost-sharing for telehealth visits paid by federal health care programs,” CMS noted.
“In 2019, Medicare started making payment for brief communications or virtual check-ins, which are short patient-initiated communications with a health care practitioner,” according to CMS. “Medicare Part B separately pays clinicians for [electronic] e-visits, which are non-face-to-face patient-initiated communications through an online patient portal. Medicare beneficiaries will be able to receive a specific set of services through telehealth including evaluation and management visits (common office visits), mental health counseling and preventive health screenings.”
According to the Renal Physicians Association (RPA), the list of approved telehealth services, by code, include the following:
- outpatient office visits (CPT codes 99201-99215);
- individual and group kidney disease education services (codes G0420-G0421);
- all outpatient dialysis services, in-center and home, adult and pediatric, monthly and daily with the exception of the single visit monthly dialysis codes for all ages (CPT codes 90956, 90959, and 90962); and
- transitional care management services (CPT codes 99495-99496).
The expanded telehealth service can be provided to both new and established patients.
In its letter to nephrologists, the RPA said the Medicare telehealth guidance “only discuss distant site practitioners, not the site where the practitioners are located, so there are to our knowledge no limitations on quarantined nephrologists providing telehealth or other remote nephrology services from, for example, their home.”