The Centers for Medicare and Medicaid Services (CMS) announced last month that it would pay for audio-only telephone visit codes at rates equivalent to the office visit codes, retroactive to March 1, 2020. The AMA subsequently received inquiries about whether the Medicare Administrative Contractors (MACs) would automatically reprocess these claims at the new rates, or if physicians would need to resubmit them. 

Today, the AMA said CMS has confirmed that the contractors will automatically reprocess audio-only claims at the new rates, as the AMA had been urging them to do. 

The March 30 Interim Final Rule with Comment Period added coverage during the public health emergency for audio-only telephone evaluation and management visits (CPT codes 99441, 99442 and 99443) retroactive to March 1. On April 30, a new Physician Fee Schedule was implemented increasing the payment rate for these codes. MACs will reprocess claims for those services that they previously denied and/or paid at the lower rate.

There are also a number of add-on services (CPT codes 90785, 90833, 90836, 90838, 96160, 96161, 99354, 99355 and G0506) that Medicare may have denied during this public health emergency. MACs will reprocess those claims for dates of service on or after March 1.

The AMA is encouraging CMS to accept information that physicians may gather about their patients' diagnoses through audio-only visits for use in their Medicare Advantage network's risk scores. In part as a response to AMA advocacy, CMS recently made a policy change to accept data gathered through audio-video telehealth visits in Medicare Advantage plan risk scores, so this recommendation would extend that change to audio-only visits.

ISMA will keep members updated on any further developments in billing, coding and reimbursement for Medicare services related to the COVID-19 public health emergency.