MIR-2006-8AB, August 2006

Medicare Telehealth Services Update

Provider Types Affected
Providers who bill Medicare carriers and fiscal intermediaries (FIs) for telehealth services

Provider Action Needed

Impact to You
When billing for telehealth services provided on or after January 1, 2006, do not use current procedural terminology (CPT) codes 99261-99263 (hospital inpatient follow-up consultations) or 99271-99275 (confirmatory consultations). These codes no longer exist, and using them could impact your reimbursement.

What You Need to Know
The American Medical Association (AMA) has deleted CPT codes 99261-99263 (hospital inpatient follow-up consultations) and codes 99271-99275 (confirmatory consultations). Effective January 1, 2006, these CPT codes no longer exist and were removed from the physician fee schedule.

What You Need to Do
Make sure that your billing staffs are aware that CPT codes 99261- 99263 and 99271-99275 are no longer usable for telehealth services.

Background
CR5122, from which this article is taken, is issued to alert you that, effective January 1, 2006; the AMA has deleted the following CPT codes:

• 99271-99275 (Confirmatory consultation); and
• 99261-99263 (Follow-up inpatient consultation).

Thus, the CPT codes that describe these services (hospital inpatient follow-up consultations – 99261 through 99263 and confirmatory consultations – 99271 through 99275) no longer exist.

In response, also effective January 1, 2006, CMS has removed confirmatory consultation and inpatient follow-up consultation from the list of Medicare telehealth services as referenced in the Medicare Benefit Policy Manual (Publication 100-02) and the Medicare Claims Processing Manual (Publication 100-04). The relevant sections of these manuals (Publication 100-02, Chapter 15, Section 270.2 [List of Medicare Telehealth Services], and Publication 100-04 Chapter 12, Section 190.3 [List of Medicare Telehealth Services]) have been revised to reflect these policy changes.

As displayed in Table 1 below, office and other outpatient consultations and initial inpatient consultations are included in Medicare telehealth consultations as described by CPT codes 99241 through 99255. The table displays the current Medicare telehealth services and CPT and HCPCS codes.

Table 1: Current Medicare Telehealth Services and Associated CPT/HCPCS Codes  

Additional Information
You can find more information about current Medicare telehealth services and the associated CPT/HCPCS codes in CR 5122, located at http://www.cms.hhs.gov/Transmittals/downloads/R53BP.pdf for the changes to Publication 100-02, Chapter 15, Section 270.2 (List of Medicare Telehealth Services) and at http://www.cms.hhs.gov/Transmittals/downloads/R997CP.pdf for the changes to Publication 100-04, Chapter 12, Section 190.3 (List of Medicare Telehealth Services).

If you have any questions, please contact your carrier/FI at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.pdf on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

MLN Matters Number: MM5122
Related Change Request (CR) #: 5122
Related CR Release Date: July 7, 2006
Effective Date: January 1, 2006
Related CR Transmittal #: R997CP and R53BP
Implementation Date: August 7, 2006

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