Telehealth Reimbursement Update: March 23, 2020
The California Medical Association (CMA) has put together a
telehealth overview resource
with the most up-to-date information, as of March 20, 2020.
CMA has been working with the major payors over the past two weeks to try to gather their policies on telehealth, which CPTs they reimburse for, whether they reimburse for the telephone visit codes, and any coding specific guidance (e.g., modifiers, etc.). While some of the large payors did respond and shared their policies earlier this week, the Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS) issued All Plan Letters this week that require plans to modify their telehealth policies.
DMHC and DHCS guidance requires commercial and Medi-Cal plans, respectively, to reimburse providers at the same rate for telehealth services as they would for services provided in person. The notices also clarify that plans must reimburse a service provided telephonically at the same rate as video.
This is welcome news for physicians. However, while the federal government has issued a waiver of HIPAA laws to allow physicians to use technologies such as Skype and FaceTime, there are some California specific privacy laws that likely still need to be waived to allow physicians to use this technology for Medi-Cal and commercial patients. CMA has urged Governor Newsom to waive CA specific privacy laws to allow physicians to use this non-HIPAA compliant technology broadly beyond Medicare patients. Until then, those privacy laws remain in effect.
The Telehealth Overview Resource will be updated at least daily, as new information comes in. Click
to view the resource.