CMS releases proposed rule for physician fee schedule update

Sept. 26, 2017

The proposed rule for the 2018 physician fee schedule touches on many topics affecting providers—telehealth services, evaluation and management guidelines, care management, and electronic records are just a few. The following are some of the highlights on telehealth:

The Centers for Medicare and Medicaid Services (CMS) proposes adding three services to the telehealth list as category I services for calendar year 2018: HCPCS Level II code G0296 for counseling visit to discuss need for lung cancer screening using low-dose CT scan, CPT code 90839 for the first hour of psychotherapy for a patient crisis, and 90840 for every additional half hour needed to treat the crisis.

Note that CMS would add the condition that the distant site practitioner be able to at least mobilize resources at the originating site (where the patient is) to defuse any crises and restore safety when the services are provided via telehealth. A key part of “mobilizing resources” is communicating with staff at the originating site sufficiently to ensure safety.

CMS also proposes adding four add-on codes to the telehealth list. They would be considered telehealth services only when billed as add-ons to codes already considered telehealth. The codes are 90785 for interactive complexity (defined by the patient’s and caregiver’s emotional states and behaviors that could hinder treatment, or communication challenges that require extra caregiver effort), 96160 for assessing the health risk of a patient, 96161 for assessing the health risk for a caregiver, and G0506 for a comprehensive assessment of and care planning for patients needing chronic care management. Optum360