March 2020
On March 17, 2020, CMS issued guidance stating that Medicare will pay for PT/OT e-visits. (This CMS guidance can be found at https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.)
This CMS guidance explains that there are three main types of virtual services physicians and other professionals can provide to Medicare patients: Medicare telehealth visits, virtual check-ins and e-visits. Physical and occupational therapists can provide e-visits. This will allow therapists to help Medicare patients who are not coming into the clinic, but the payment is minimal.
The following are requirements and other information regarding e-visits provided by physical and occupational therapists.
- An e-visit is a patient-initiated online assessment and management conducted via a patient portal. The CMS publication states that HHS will exercise enforcement discretion and waive penalties for HIPAA violations against providers that serve patients in good faith through everyday communication technologies, such as FaceTime or Skype, during the COVID-19 emergency.
- The patient must generate the initial inquiry; however, the provider may educate patients on the availability of an e-visit prior to the patient initiation. So, for example, if a patient calls to cancel an appointment, the patient can be told that they can contact their therapist or otherwise schedule an e-visit.
- The medical practice must have an established relationship with the patient. The patient can be located anywhere. E-visits are not limited to rural areas.
- The patient must verbally consent to receive virtual check-in services. This consent can be obtained during the e-visit.
- Communications can occur over a seven-day period. (E-visits are intended for short-term consultations, not ongoing 4-6 week therapy treatments.)
- The Medicare deductible and coinsurance applies to these services.
- Physical and occupational therapists can use the following codes for e-visits:
- G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the seven days; 5-10 minutes
- G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the seven days; 11-20 minutes
- G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the seven days; 21 or more minutes
- The Medicare national payment rates for these codes are:
- G2061-$12.27
- G2062-$21.65
- G2063-$33.92
Your actual Medicare payment will be adjusted based on your location, but your payment will be very close to the amounts shown above. Although it is not entirely clear, it appears that only one of these codes can be billed for all e-visit services provided during a 7-day period.
