The growing integration of telemedicine into clinical practice took a major step forward recently with the establishment of an American Medical Association workgroup tasked with developing new billing codes for telemedicine services.
The AMA’s Telehealth Services Workgroup met for the first time on October 8, 2015, in Philadelphia to begin considering additions to the Current Procedural Terminology (CPT) code set to cover newly emerging telemedicine services. The new workgroup includes more than 50 experts representing physicians, other health professionals, health insurers, and telemedicine innovators.
According to an article posted at ModernHealthcare.com, Medicare already accepts claims that are filed with more than a dozen existing CPT billing codes for telemedicine services. Such services already covered by CPT codes include office visits, consultation in hospital emergency rooms, and smoking cessation services, as well as alcohol abuse and depression screenings.
List Expanded in 2015
In 2015, the Centers for Medicare and Medicaid Services expanded its list of reimbursable telemedicine services to include annual wellness exams, psychoanalysis, psychotherapy, and prolonged evaluation and management services.
Of the important role played by the CPT code set, AMA President Steven J. Stack, M.D., said it “is the foundation upon which every participant in the medical community — physicians, hospitals, allied health professionals, payers, and others — can efficiently share accurate information about medical services.” He went on to say that input from the workgroup will hopefully update the CPT code set to reflect both technological and telemedicine advances as they become available to mainstream clinical practice. Dr. Stack said such changes are necessary to ensure that the CPT code set fulfills “its role as the health system’s common language for reporting contemporary medical procedures.”
Code Set Changes Also Considered
In addition to proposing new CPT billing codes for telemedicine-provided services, the AMA workgroup will review current codes and recommend changes when they feel changes are appropriate. The workgroup’s recommendations for additions and changes to the CPT code set will then be passed along to the AMA’s Common Procedural Terminology Editorial Panel, which creates and curates the billing codes for physician services.
In subsequent meetings, the workgroup will probably divide itself into subgroups representing different medical disciplines and then review existing areas of telemedicine practice to determine those most in need of new billing codes. Once they have identified these high-priority needs, the subgroups will attempt to come up with code recommendations that can then be sent to the editorial panel for final action.
In an interview with ModernHealthcare.com blogger Joseph Conn, some of the members of the newly created Telehealth Services Workgroup acknowledge that the recent explosive growth in telemedicine puts the AMA in the position of playing catch-up. Frank Dubeck, M.D., one of the workgroup’s four co-chairmen, said that the sharp increase in insured patients under the Affordable Care Act ensure that telemedicine is here to stay and likely to experience continued robust growth. Dr. Dubeck specializes in internal medicine and serves as the chief medical officer for medical policy and clinical editing at Excellus BlueCross BlueShield in Rochester, New York.
Another Way to Deliver Services
Dr. Dubeck told Conn that while telemedicine will never replace traditional in-person encounters between health care providers and patients, it does provide yet another way to deliver health care services to those who need them most. He said that the creation of the new workgroup is AMA’s acknowledgment that “the current code set is not meeting the needs of providers, vendors, and payers” in the face of rapid technological advances.
Barbara Levy, M.D., another co-chairman of the new workgroup, pointed out to Conn that dozens of existing CPT codes for face-to-face patient encounters can be bootstrapped into service to bill Medicare for telemedicine services simply by adding a “GT” modifier. However, she said that additional billing codes will be needed to cover other telemedicine services, particularly in the realm of bundled payments for patient-centered care. In addition to her post on the workgroup, Dr. Levy is vice president for health policy at the American Congress of Obstetricians and Gynecologists.
American Well Partners with Blues
In other recent developments on the telemedicine front, American Well, a Boston-based telemedicine services provider, announced that it has reached an agreement to partner with 29 independent Blue Cross and Blue Shield plans serving patients in 26 states. This partnership, which goes into effect on January 1, 2016, will allow patients insured by these Blue plans to consult with doctors immediately on a 24/7 basis via telemedicine consultation.
Of this new, far-reaching partnership agreement, American Well CEO Roy Schoenberg, M.D., said, “It made perfect sense to partner with the Blues, who have been long-standing leaders in bringing health care to consumers, to deliver online care to their networks.” Health insurers, including not just the Blues but also Anthem, Cigna, and UnitedHealth, have been introducing new telemedicine options as yet another way to attract more customers.
Pilot Program Launched
In March of 2015, Blue Cross Blue Shield of Massachusetts launched a two-year telemedicine pilot program with American Well. Under the pilot program, the health insurer will allow select patients to interact with their primary care physicians through online video as an alternative to in-person visits.
In its press release announcing the program, Blue Cross Blue Shield of Massachusetts said that “health care providers in the two-year pilot will assess and treat patients with select health conditions. . . . For example, some may use it for check-ups to monitor recovery from concussions, others may use video visits for wellness coaching, to follow up with patients on certain medications, or to check in after a procedure or hospitalization to monitor recovery and help prevent rehospitalizations.”
CareFirst to Invest More
In a related development, Baltimore-based CareFirst BlueCross BlueShield announced recently that it plans to make a hefty investment to help develop innovative telemedicine programs that improve access to health care and increase efficiency. CareFirst said it plans to award grants of up to $3 million over the next three years as part of its multi-front efforts to remove barriers to health care and address disparities in health care outcomes within its service area.
While acknowledging that telemedicine has already helped to increase access to health care in its service area, Maria Tildon, CareFirst senior vice president of public policy and community affairs, noted that certain disparities remain. “Barriers including access to providers, lack of transportation, and others, should not prevent those in need from receiving quality health care, and this investment will directly impact the underserved communities in our region lacking adequate health care services.”
As for the overall outlook for telemedicine, U.K.-based professional services firm Deloitte in August 2014 published a study that estimated telemedicine visits would reach a total of 75 million in 2014. It also calculated that the potential exists for at least 300 million visits a year. One indication of the growing acceptance of telemedicine as a cost-efficient way to provide much-needed health care services came from a 2014 Towers Watson survey that found 37 percent of employers planned to offer their employees access to telemedicine consultations by the end of 2015. The same survey predicted that an additional 34 percent of employers will jump on the telemedicine bandwagon by 2017.
This is just one of several articles about telemedicine and related health issues we cover. To check out that content, go to our blog.
Don Amerman is a freelance author who writes extensively about a wide array of nutrition and health-related topics.
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