Broader Medicare Reimbursement for Providing Telemedicine Seems Doubtful
by Stephen Barlas| Geriatric Times |  |
November/December 2000 | |
Vol. I | |
Issue 4 |
Current Medicare limitations on payments to physicians and other health care providers for telemedicine consultations have caught the attention of some members of the U.S. Congress. The limitations were put in place by the Balanced Budget Act (BBA) of 1997, which allowed Medicare to pay for telemedicine consultations for Medicare recipients beginning in January 1999.
As a result, less than 6% of telemedicine physician-patient visits provided in 1999 to Medicare recipients qualified for Medicare reimbursement, according to Sen. James Jeffords (R-Vt.) in an interview with Geriatric Times. Jeffords has introduced the Telehealth Improvement & Modernization Act (S. 2505), which has a substantial list of bipartisan co-sponsors. An almost identical House bill (H.R. 4841) has also been introduced.
Right now, Medicare reimbursement is available for a narrow range of CPT consultation codes-99241-99275. To be eligible, the patient must live in a Health Professional Shortage Area, a federal designation made by the U.S. Department of Health and Human Services.
Moreover, the physician who does the consultation must give 25% of the fee to the physician who makes the referral. A telepresenter must be at the remote site where the audiovisual transmission takes place. Health care professionals such as nurses; occupational, physical and speech therapists; clinical social workers; and others who typically make telemedicine presentations to distant physicians do not qualify as presenters under Medicare.
The Jeffords bill would change that. No telepresenter would be necessary. A larger number of CPT codes could be billed, including some for direct patient treatment. The additions would be 99201-99215, 90804-90815 and 90862. Patients would also be eligible if they lived in a county that is not included in a Metropolitan Statistical Area, an inner-city neighborhood that is underserved or an area where there is a federal telemedicine demonstration program.
Medicare's reimbursement for telemedicine lags far behind many private payers and even federal Medicaid. Blue Cross/Blue Shield (BC/BS) of Montana was one of the first third-party payers to reimburse for telemedicine, starting in 1993. BC/BS uses the Eastern Montana Telemedicine Network in Billings, Mont., which runs 13 remote locations.
Mary Patrick, the director of quality management at BC/BS of Montana, testified on Sept. 7 to the House Subcommittee on Health and Environment that the referring and consulting physicians are both paid separate fees, the first for an office visit, the second for a consultation visit.
The fate of the Jeffords' bill in 2000 rests on Congress' willingness to pass a much larger bill restoring Medicare payments to various provider groups who contend they have been hurt by reimbursement cuts imposed by the BBA. Prospects for any larger bill seemed doubtful as the session drew to a close.