The American Medical Association recently announced that it held the foundational meeting for a workgroup tasked with developing reimbursement codes based on telehealth services innovations like increasingly common remote visit tools & chronic disease management apps.
According to the AMA, these codes will eventually be included in the Current Procedural Terminology (CPT®) code set – well known as the most common coding system for medical procedures and services in the US. The workgroup is called, “Telehealth Services Workgroup.” The AMA’s website for the CPT code set indicates that the Workgroup “will recommend additions and changes to the CPT code set related to medical services utilizing telehealth technology.”
The workgroup includes over 50 experts that include health professionals of various specialties, telehealth innovators, and health insurers. The inclusion of insurers will aid in moving any new or modified codes into practice quickly. With some evidence that telehealth services may lead to cost savings for insurers, this workgroup is likely to see its best suggestions implemented rapidly by insurers. The Workgroup has a substantial charge from the AMA which is as follows:
- “Recommend solutions for the reporting of current non-telehealth services when using remote telehealth technology (to include but not limited to E/M services). Considerations will include potential new codes, use of current codes without or with modifier, add-on code(s).
- Address the accuracy of current code set in describing the services provided when telehealth data is reviewed and analyzed, including potential code set revisions and/or education for:
- Appropriate code use (e.g., E/M versus data analysis codes);
- Potential code development to report analysis of transmitted data;
- Definition of data types whose interpretation will require differentiation and consideration of separate reporting of current E/M services/codes
- Potential new E/M services codes based on emerging new patterns for sites of service.
- Recommend whether any other telehealth service codes should be developed based upon services currently being provided.
- Develop new introductory language or modify existing introductory language to guide coding of telehealth services.”
The charge is nothing short of a substantial modernizing of the existing telehealth services codes. The Workgroup plans to assess proposals on expansion to CPT based on emerging telehealth services. One key starting place will be the new list of reimbursable telehealth services developed by the Centers for Medicare and Medicaid Services (CMS) – the largest insurer in the US.
According to an article by The National Law Review, that list includes: “annual visits, psychoanalysis, psychotherapy, and long-term evaluation and management services, all of which will need new codes.” It’s important to note, however, that these covered telehealth services are subject to major geographic restrictions that make them available to a small minority of Americans.
If the Workgroup maintains ongoing connections with innovators and researchers in this area, it will serve as a key tool for translating research and innovation into practice. This bodes well for the field of mHealth and for patients who seek to utilize these technologies. The Workgroup’s assessment of new telehealth innovations will also help researchers and innovators determine what types of innovations are likely to meet the pragmatic needs of the medical field.