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Medicare Telehealth Services Update for Nursing Facility

The nursing facility services provided to Medicare patients are covered during the PHE for physicians, non-physician practitioners, nursing facilities, and other providers submitting telehealth claims to Medicare Administrative Contractors (MACs).

For subsequent nursing facility care services, Medicare had limited the patient’s admitting physician or non-physician practitioner to one telehealth visit every 30 days.

CMS is changing this limitation to once every 14 days. Also, you may not furnish or report subsequent nursing facility care services for a Federally-mandated periodic visit through telehealth. 

The frequency limit of the benefit doesn’t apply to consulting physicians or practitioners, who should continue to report initial or follow-up inpatient telehealth consultations using the applicable HCPCS G-codes.

For this edit change, (Common Working File) CWF revises the current line-level edits from once every 30 days to allow a frequency of once every 14 days for the following codes when billed with the GT or GQ modifier or Place of Service (POS) code 02, effective for claims with dates of service on or after January 1, 2021, that are processed on or after July 6, 2021,

Subsequent nursing facility care, Which requires at least 2 of these 3 key components,

  • 99307 - A problem focused interval history, A problem focused examination & Straightforward - MDM
  • 99308 - An expanded  focused interval history, An expanded  focused examination & Low Complexity MDM
  • 99309 - A Detailed interval history, A Detailed examination & Moderate Complexity MDM
  • 99310 - A Comprehensive interval history, A Comprehensive examination & High Complexity MDM

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