AMA Offers Guidelines for Telehealth Reimbursement During the Pandemic

The American Medical Association has released a guide to help providers get paid for their telehealth services during the Coronavirus (COVID-19) pandemic.

The new document outlines 11 different scenarios for treating patients, and the appropriate CPT codes to qualify for Medicare reimbursement. All take into account the emergency actions announced earlier this month by the Centers for Medicare & Medicaid Services to remove barriers to the use of connected health platforms.

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“Equipping a health care workforce to accurately code medical procedures streamlines communication across the health system, reducing administrative and rework costs at a time when resources are stretched by the COVID-19 pandemic,” AMA President Patrice A. Harris, MD, said in a press release. “The AMA’s new special coding advice provides guidance to the right audience at the right time in a format that is easily grasped by users.”

Nine of the examples listed pertain to telehealth:

1. A patient is treated via telehealth for an E/M visit, then told to come into the doctor’s office for testing.
2. A patient is treated via telehealth, then sent to an unaffiliated test site.
3. A patient is treated online or through a virtual check-in for something not related to an E/m visit, then told to come into the doctor’s office for a test.
4. A patient is treated online or through a virtual check-in for something not related to an E/M visit, then sent to an unaffiliated test site.
5. A patient diagnosed with Coronavirus is treated via telehealth.
6. A patient diagnosed with Coronavirus is seen online or through a virtual check-in through the patient portal or by e-mail (not related to an E/M visit) or via a phone call from a qualified non-physician (someone who may not report an E/M).
7. Following a Coronavirus diagnosis, the physician orders remote physiologic monitoring and home quarantine.
8. A patient is treated via telehealth for something not related to the Coronavirus.
9. A patient need treatment for something not related to the Coronavirus is treated via virtual check-in or online through the patient portal or e-mail (not E/M-related) or a phone call from a qualified non-physician.

The guidance adds to the growing number of online resources available to care providers seeking more information on how to use telemedicine and mHealth technology during the emergency.

The AMA has several documents on its website, while the Center for Connected Health Policy is keeping track of emergency actions taken by each state to improve telehealth coverage during the pandemic and the Federation of State Medical Boards is maintaining a database of state actions taken to support license portability.