CMS reimbursement changes in healthcare include expansion for telehealth platforms, including eConsults

With healthcare spending in the United States projected to continue to rise through 2027, innovations designed to improve access to healthcare while reducing costs are more crucial now than ever. By making access to specialty care more convenient and reducing the cost of care, virtual care is  one such innovation. 

In recognizing the value of virtual care, positive support for connected health has been included in the 2019 CMS fee structure change objectives. These changes to the CMS fee structure have made several telehealth services reimbursable for physicians, including virtual check-ins, eConsults (CPT code 99451), and remote patient evaluation.

Updated 2020 telehealth reimbursements

Interprofessional internet consultations (eConsults)

eConsults increase access and improve quality of care for patients with low-acuity conditions who can be treated without an in-person specialist visit. As a downstream effect, these platforms also help to increase appointment availability for patients who urgently need to schedule appointments with specialists.

For Medicaid programs, eConsults are explicitly covered under CPT code 99451 and 99452 in Connecticut, Kentucky, Michigan, Minnesota, Montana, Nebraska, and Utah.

CPT code Description Amount reimbursed
99451
Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician including a written report to the patient’s treating/requesting physician or other qualified healthcare professional; 5 or more minutes of medical consultative time.
$37.48
99452
Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified healthcare professional; 30 minutes.
$37.48

Virtual check-ins

Virtual check-ins refer to brief non-face-to-face interactions with patients via communication technology, often via telephone. They are an effective way of mitigating unnecessary office visits and improving healthcare efficiency as a result. Adding reimbursement conditions for virtual check-ins makes adopting this procedure more viable for physicians.

CPT code Description Amount reimbursed
G2012
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
$14.78

eConsults are reducing over 70% of unnecessary specialist referrals.

Remote evaluation of pre-recorded patient information

Technology for forwarding patient information via video or images, often referred to as “store-and-forward,” has been useful in facilitating remote triage, diagnosis, and treatment. This has generally not been reimbursable under the Medicare telehealth benefit, but CMS has proposed a new code to address this: HCPCS G2010.

CPT code Description Amount reimbursed
G2010
Remote evaluation of recorded video and/or images submitted by the patient (e.g., store and forward), including interpretation with verbal follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment
$12.61

Remote patient monitoring

Patients with chronic conditions often face many challenges in receiving quality care, with the largest obstacles being the high cost of repeated office visits for monitoring of physiological data and the ability to receive care in a timely fashion. With added reimbursement codes to facilitate the adoption of RPM by increasing numbers of physicians, these patients will see a large increase in the quality, timeliness, and affordability of their care.

CPT code Description Amount reimbursed
99453
Remote monitoring of physiologic parameter(s) (e.g, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.
$19.46
99454
Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
$64.15
99457
Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
$51.54

Find out how eConsults can support your organization

CMS reimbursement