Telehealth Claim Lines Stabilize After Months of Decline

The percentage of telehealth claim lines has stabilized at about 5 percent of medical claim lines, indicating a new balance of virtual and in-person care.

The analysis conducted by FAIR Health as part of its Monthly Telehealth Regional Tracker included data representing the privately insured population, including Medicare Advantage, and excluded Medicare fee-for-service and Medicaid claims data.

The data revealed that the percentage telehealth claim lines increased slightly to 5 percent in May 2021, from 4.9 percent the previous month. The slight increase suggests a stabilization of telehealth utilization since telehealth claim lines had declined each month from February to April of this year.

In May 2021, the percentage of telehealth claim lines only declined in the Midwest by 5.4 percent and the Northeast by 1.7 percent. In the South and West, telehealth claim lines increased as just they did nationally, FAIR Health reported.

Telehealth was a shining star during the COVID-19 pandemic. Virtual care options maintained access to care during the height of the pandemic when communities shut down to stymy the spread of the novel coronavirus.

But when communities started to resume in-person activities, including visits to the doctor’s office, providers had to find a new balance of telehealth and in-person care.

FAIR Health’s data reveals a new trend in telehealth utilization as measured by medical claim lines. For example, telehealth is largely being used for mental health services, according to the most recent claims data from May.

The top procedure code in May was CPT 90837 for 60 minutes of psychotherapy. A 45-minute psychotherapy session (CPT 90834) and a 30-minute psychotherapy session performed with an evaluation and management visit (CPT 90833) also made the top five telehealth procedures codes that month.

Additionally, mental health conditions dominated the top diagnoses according to the telehealth claims lines data.

Rounding out the top five procedure codes listed on telehealth claim lines in May 2021 was an established outpatient patient visit lasting 20 to 29 minutes (CPT 99213) and established outpatient patient visit lasting 30 to 39 minutes (CPT 99214). At the height of the first surge of COVID-19 in April 2020, these codes were the top procedure codes associated with telehealth claim lines.

Providers are finding a happy home for telehealth now that most organizations have implemented the technology in light of the pandemic. But sustaining the gains made will hinge on telehealth reimbursement moving forward.

CMS and many private payers made concessions during the pandemic to allow providers to leverage telehealth to maintain access to care. As part of this, the payers agreed to reimburse providers for expanded telehealth utilization, with some providing payment parity with in-person visits when communities shut down.

However, the payment flexibilities were only temporary and many have expired since positive cases of the coronavirus declined across the country.

Providers are still pushing for more telehealth reimbursement though, especially since patient satisfaction with telehealth visits was high during the pandemic.

“Telehealth is not a COVID-19 novelty, and the regulatory flexibilities granted by Congress must not be viewed solely as pandemic response measures,” a recent letter from the eHealth Initiative to key congressional leaders stated.

“Patient satisfaction surveys and claims data from CMS and private health plans tell a compelling story of the large-scale transformation of our nation’s health care system over the past year and, importantly, demonstrate strong patient interest and demand for telehealth access post-pandemic.”

CMS has proposed to expand telehealth reimbursement, especially for mental health services, as part of the Medicare Physician Fee Schedule next year.

“The COVID-19 pandemic has put enormous strain on families and individuals, making access to behavioral health services more crucial than ever,” CMS Administrator Chiquita Brooks-LaSure said at the time. “The changes we are proposing will enhance the availability of telehealth and similar options for behavioral health care to those in need, especially in traditionally underserved communities.”