April 3, 2020 - Update from Centers for Medicare and Medicaid Services
Billing for Professional Telehealth Distant Site Services During the Public Health Emergency — Revised
This corrects a prior message that appeared in our March 31, 2020 Special Edition.
Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. When billing professional claims for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with:
- Place of Service (POS) equal to what it would have been had the service been furnished in-person
- Modifier 95, indicating that the service rendered was actually performed via telehealth
As a reminder, CMS is not requiring the CR modifier on telehealth services. However, consistent with current rules for telehealth services, there are two scenarios where modifiers are required on Medicare telehealth professional claims:
- Furnished as part of a federal telemedicine demonstration project in Alaska and Hawaii using asynchronous (store and forward) technology, use GQ modifier
- Furnished for diagnosis and treatment of an acute stroke, use G0 modifier
There are no billing changes for institutional claims; critical access hospital method II claims should continue to bill with modifier GT.
Trump Administration Issues Key Recommendations to Nursing Homes, State and Local Governments
On April 3, at the direction of President Trump, the Centers for Medicare & Medicaid Services (CMS), in consultation with the Centers for Disease Control and Prevention (CDC), issued critical recommendations to state and local governments, as well as nursing homes, to help mitigate the spread of the 2019 Novel Coronavirus (COVID-19) in nursing homes. The recommendations build on and strengthen recent guidance from CMS and CDC related to effective implementation of longstanding infection control procedures.
Press Release and Guidance
Billing for Multi-Function Ventilators (HCPCS Code E0467) under the COVID-19 Public Health Emergency and Otherwise
CMS recognizes that in these important times, in particular, beneficiaries, health care clinicians, suppliers, and manufacturers are looking for the broadest possible access to ventilators for their care needs. We are taking a number of steps to increase access to and remind suppliers about certain options available to them and beneficiaries regarding multi-function ventilators.
Effective immediately, CMS is suspending claims editing for multi-function ventilators when there are claims for separate devices in history that have not met their reasonable useful lifetime. For more information on multi-function ventilators, see MLN Matters Special Edition Article SE20012.
New ICD-10-CM diagnosis code, U07.1, for COVID-19
In response to the national emergency that was declared concerning the COVID-19 outbreak, a new diagnosis code, U07.1, COVID-19, has been implemented, effective April 1, 2020. As a result, an updated ICD-10 MS-DRG GROUPER software package to accommodate the new ICD-10-CM diagnosis code, U07.1, COVID-19, effective with discharges on and after April 1, 2020, is available on the CMS MS-DRG Classifications and Software webpage. This updated GROUPER software package (V37.1 R1) replaces the GROUPER software package V37.1 that was developed in response to the new ICD-10-CM diagnosis code U07.0, Vaping-related disorder, also effective with discharges on and after April 1, 2020, that is currently available on the MS-DRG Classifications and Software webpage. Providers should use this new code, U07.1, where appropriate, for discharges on or after April 1, 2020. Refer to the updated MLN Matters Articles for additional Medicare Fee-For-Service information:
For detailed information regarding the assignment of new diagnosis code U07.1, COVID-19, under the ICD-10 MS-DRGs, visit the MS-DRG Classifications and Software webpage. The announcement is located under the “Latest News” heading. For additional information related to the new COVID-19 diagnosis code, visit the CDC website.
March 28, 2020 - Cybersecurity & Infrastructure Agency (CISA) updates guidance on critical infrastructure
The Cybersecurity and Infrastructure Agency (CISA), part of the Department of Homeland Security, released updated guidance on critical infrastructure. Social workers are included as part of the critical Healthcare & Public Health sector. For more information:
March 19, 2020 - HIPAA Information
The Office of Civil Rights (OCR) in the US Department of Health and Human Services is relaxing its enforcement of HIPAA regulations governing telehealth during the COVID-19 National Emergency. Please read the notice at this link. Because this is a federal announcement, we are not in a position to answer questions or offer clarification on this issue.
March 17 - CMS Issues Teletherapy Guidance for Clinical Social Workers with Medicare Clients
The Centers for Medicare & Medicaid Services (CMS) issued guidance late today allowing telehealth for Medicare beneficiaries--a victory for NASW and other advocates who have been pushing for the move in light of the COVID-19 pandemic. Clinical social workers now can provide teletherapy to beneficiaries if a new or existing client is in their home. There will be no audits to determine prior relationship. Telephone/audio-only is not reimbursable; CSWs must use a videoconferencing platform, which should be easier since HIPAA requirements are also eased. For full details, visit http://bit.ly/MedicareTeletherapyGuidance. Graphic source: cms.gov
March 17, 2020 - Closure of U.S.- and Canada-based Pearson VUE-owned Test Centers
Due to increasing concern for the health and safety of candidates and employees, and in response to government guidance and difficulty procuring the critical hygienic products that keep its test centers safe, Pearson VUE has temporarily closed its U.S.- and Canada-based test centers as of March 17.
Candidates can reschedule their exams for appointments starting April 16 and beyond if conditions allow.
If you already have a scheduled exam:
You will receive an email cancellation notice, and you will either receive a refund (if paid to Pearson VUE) or an extension as determined by your exam sponsor. The company will work with you to reschedule your exam as soon as it is safe to resume test delivery (on or after April 16).
If you are looking to schedule an exam:
Registration windows for new exam appointments will not be available until April 16. If you have additional questions regarding voucher usage or testing windows, please visit your exam program homepage to speak to the customer service team associated with your program.
To monitor the company’s COVID-19 website, visit https://home.pearsonvue.com/coronavirus-update
March 16, 2020 - Update on NASW Actions on Telehealth and Reimbursement
Possible changes are moving forward quickly to Medicare and coverage for teletherapy, specifically for those who are in their homes. In early March, Congress passed a bill around COVID-19 that includes a telehealth provision.
Its provisions cannot be implemented until the Centers for Medicare and Medicaid Services (CMS) issues regulatory guidance. According to NASW, the department plans to do this March 19. Several members of Congress have implored the agency to move faster and to ensure that the telehealth provisions are “good” (not just for teletherapy but in general, for numerous types of provider scenarios).
Along with several of its mental health allies, NASW is sending a letter shortly to CMS to urge them to prioritize mental health support and in-home teletherapy in the guidance.
NASW also has been working with the Association of Social Work Boards (ASWB) to provide information to members about emergency waivers and other aspects related to interstate teletherapy and loosening related state licensing rules due to the pandemic. That information will go on the NASW COVID-19 website, as will updates on this topic.
Lastly, NASW will provide updates on the issue of telehealth parity on its national COVID-19 website.
As for the social justice implications of the virus, NASW is working on a likely public statement and deciding on other actions to ensure economic relief and other supports. all in the loop on this important dimension of the crisis and our nation’s response to it.
This national emergency and leaders’ responses to it are an example of how important it is to have social workers in these key government leadership positions!
March 14, 2020 - Medicare & Medicaid FAQs
Today, the Centers for Medicare & Medicaid Services issued Frequently Asked Questions to Ensure Individuals, Issuers and States have Clear Information on Coverage Benefits for COVID-19. This action is part of the broader, ongoing effort by the White House Coronavirus Task Force to ensure that all Americans – particularly those at high-risk of complications from the COVID-19 virus – have access to the health benefits that can help keep them healthy while helping to contain the spread of this disease.
The COVID-19 FAQs for EHB can be found here: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/EHB-Benchmark-Coverage-of-COVID-19.pdf
These FAQs, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.