Telehealth Gets A Boost From CMS Final Payment Rules For 2021

F.J. Thomas

Sarasota, FL ( – The pay reductions proposed by the Centers for Medicare and Medicaid Services earlier this year had several specialties in an uproar as projected analytics reflected reimbursement cuts as high as 8 percent, depending on the procedure code. Earlier this week, CMS announced the final payment and policy changes for 2021.

While the original proposal included a reduction of the conversion factor by just over 10.6 percent from $36.09 in 2020 to $32.26, the final reduction was slightly less. For the 2021 ruling, the conversion factor is $32.41, resulting in a $3.68 reduction, or 10.2 percent.

Although reimbursement rates for many procedure codes are negatively impacted due to the decrease in the conversion factor, telehealth received quite the boost with new telehealth services added to the list for 2021, along with further clarification on some issues.

New telehealth services added as a Category 1 to the listing include:

  • CPT 90853 – Group Psychotherapy
  • CPT 96121 – Psychological and Neuropsychological Testing
  • CPT 99334-99335 – Domiciliary, Rest Home, or Custodial Care services for established patients
  • CPT 99347-99348 – Home care for established patients
  • CPT 99483 – Cognitive assessment and care planning
  • HCPCS code G2211 – Visit Complexity Inherent to Certain Office/Outpatient Evaluation and Management
  • HCPCS code G2212 – Prolonged services

In regards to nursing facility telehealth charges, the final rule set the limit to one visit every 14 days.

Additionally, CMS created and finalized a Category 3 list for telehealth services that are to be used until the end of a public health emergency. These include:

  • CPT 99336-99337 – Domiciliary, Rest Home, or Custodial Care services for established patients
  • CPT 99349-99350 – Home visits for established patients
  • CPT 99281-99285 – Emergency Department visits, Levels 1-5
  • CPT 99315-99316 – Discharge planning for Nursing Facility patients
  • CPT 96130-96133; CPT codes 96136-96139 – Psychological and Neuropsychological Testing
  • CPT 99238-99239 – Hospital discharge management
  • CPT 99291-99292 – Critical care
  • CPT 99217; 99224-99226 – Subsequent Observation and Observation Discharge Day Management
  • CPT 90952, 90953, 90956, 90959, 90962 – End-Stage Renal Disease Monthly Capitation Payment

An extensive range of Physical and Occupational Therapy codes for all levels was also added for the Category 3 list. Therapy codes added include codes 97161-97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, and 92507. Additionally, CMS ruled that physical and occupational therapists can delegate maintenance therapy services when appropriate to a physical or occupational therapy assistant.

The final rule also clarified that the telehealth rules do not apply if the patient and the provider are in the same location during the virtual visit.

You can read the full final release on the CMS website.

News brought to you by