Medicare Payments Currently Lower for Telephone-Based Telehealth Services for Patients

  U.S. Senators Joe Manchin (D-W.Va.), Cindy Hyde-Smith (R-Miss.), Jeanne Shaheen (D-N.H.), and Jerry Moran (R-Kan.) today led 37 Senators in advocating for the U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) to increase telephone-based, or audio-only, telehealth reimbursements to equal other audio-visual telehealth and in-person visitation reimbursements.

Many Americans lack access to reliable broadband, making it nearly impossible to use video sharing to receive telehealth services during the COVID-19 pandemic.  Instead, they must turn to telephone-based telehealth services.  However, healthcare professionals who provide these services are not receiving the same Medicare reimbursement for telephone-based consultations as they would for visual or in-person consultations.

As COVID-19 continues to spread in communities across the United States, millions of people are following directives to stay home and avoid risking exposure to the virus.  In conjunction with those directives, health care providers have shifted to offering audio-visual telehealth services to patients, so that patients can receive evaluations, medical consultations, checkups and other services in their own homes, instead of risking exposure at a health care facility.  However, for instances where a patient has no home access to internet, broadband or other cell phone services, physicians and other providers are furnishing these medical consultations through audio-only formats, such as telephone calls,” the Senators wrote.

Manchin, Hyde-Smith, Shaheen, and Moran were joined by Senators:  Roger Wicker (R-Miss.), John Boozman (R-Ark.), Shelley Moore Capito (R-W.Va.), Kevin Cramer (R-N.D.), Dan Sullivan (R-Alaska), Sherrod Brown (D-Ohio), Elizabeth Warren (D-Mass.), Doug Jones (D-Ala.), Bernie Sanders (I-Vt.), Jack Reed (D-R.I.), Amy Klobuchar (D-Minn.), Maggie Hassan (D-N.H.), Debbie Stabenow (D-Mich.), Kamala Harris (D-Calif.), Tina Smith (D-Minn.), Kyrsten Sinema (D-Ariz.), Susan Collins (R-Maine), Michael Bennet (D-Colo.), Lisa Murkowski (R-Alaska), David Perdue (R-Ga.), Angus King (I-Maine), Patrick Leahy (D-Vt.), Dick Durbin (D-Ill.), Cory Gardner (R-Colo.), Edward Markey (D-Mass.), Tim Scott (R-S.C.), John Hoven (R-N.D.), Gary Peters (D-Mich.), Steve Daines (R-Mont.), Bob Menendez (D-N.J.), Richard Blumenthal (D-Conn.), Jon Tester (D-Mont.), and James Lankford (R-Okla.).

This letter is supported by:  Mississippi Academy of Family Physicians, American Academy of Hospice and Palliative Medicine, American Academy of Family Physicians, American Academy of Physical Medicine and Rehabilitation, American College of Physicians, American College of Rheumatology, American College of Surgeons, American Gastroenterological Association, American Geriatrics Society, American Medical Group Association, American Psychiatric Association, American Society for Transplantation and Cellular Therapy, American Telemedicine Association, Endocrine Society, Medical Group Management Association, and the Primary Care Collaborative.

The letter is available below and here.

Dear Secretary Azar and Administrator Verma: 

We write to draw your urgent attention to concerns that we have heard from health care providers and patients regarding Medicare’s coverage and payment rules during the outbreak of the novel coronavirus or “COVID-19.”  In order to ensure that Medicare beneficiaries in all regions of the country can have access to health care services during this time, we strongly urge you to address Medicare payment differences that exist between audio-visual telehealth services and audio-only medical consultations. 

As COVID-19 continues to spread in communities across the United States, millions of people are following directives to stay home and avoid risking exposure to the virus.  In conjunction with those directives, health care providers have shifted to offering audio-visual telehealth services to patients, so that patients can receive evaluations, medical consultations, checkups and other services in their own homes, instead of risking exposure at a health care facility.  However, for instances where a patient has no home access to internet, broadband or other cell phone services, physicians and other providers are furnishing these medical consultations through audio-only formats, such as telephone calls. 

Access to audio-only telephone-based services during this time is not only important for Medicare beneficiaries with limited means, but is also vital for Medicare patients who live in communities that lack sufficient broadband and internet connectivity.  For these communities, telehealth services provided through internet based visual platforms are simply not an option.

While we appreciate the effort of CMS to provide expanded coverage for audio-only services, the current reimbursement rates for audio-only services are not sufficient to make audio-only medical consultations a viable option for many health care providers.  While audio-only consultations may not be appropriate in all clinical circumstances, providers across the country who have been able to conduct successful audio-only telephone visits with patients when clinically appropriate.  We support their efforts to continue offering medical care to our most at-risk populations in their homes and ask that CMS make this care sustainable for providers by ensuring sufficient payment for telephone consultations when clinically appropriate during the COVID-19 outbreak.  Your access to healthcare should not be determined by your access to broadband when other approaches are available.  

In light of this critical need to better support the provision of audio-only services for Medicare beneficiaries who may lack access to broadband or have limitations that prevent the use of audio-visual telehealth services during the COVID-19 outbreak, we urge you to: 

  1. Increase Medicare payment rates for telephone-based evaluation and management (E/M) codes (99441-99443) to bring payments for these codes equal to Medicare’s established in person visit codes (99212-99214) that will ensure that patients without advanced video-sharing capabilities are able to get care virtually, while helping to sustain physician practices.
  2. Immediately provide guidance to Medicare Administrative Contractors (MACs) to ensure that recent CMS guidance and rules are followed appropriately to enable the payment of telephone E/M claims.
  3. Provide Members of Congress with a briefing on your efforts to address this issue by May 8, 2020.

We appreciate recent steps taken to expand telehealth for health care providers. Expanding access to telehealth services has been vital to our collective effort to respond to the COVID-19 crisis.  In order to maximize the potential of at-home care during this public health emergency, CMS must provide adequate payment for audio-only services, in addition to audio-visual telehealth services. Thank you for your attention to this matter.