The Centers for Medicare & Medicaid Services (CMS) published the 2021 Medicare Physician Fee Schedule (PFS) final rule on Dec. 1, 2020, expanding Medicare-covered telehealth services to similar services already covered under the Medicare program. Please note:
- While certain audio-only services are covered by Medicare telehealth services, Humana maintains that in order for services to meet risk adjustment eligibility, the visit must be performed using a real-time interactive audio and video telecommunications service.
- Healthcare providers should bill real-time, interactive audio- and video-covered services using Current Procedural Terminology (CPT®) telehealth modifier “95” with any place of service (POS) and the appropriate CPT and HCPCS codes.
As we continue to navigate the coronavirus disease 2019 (COVID-19) outbreak, we are committed to supporting you in the care of your patients. To make working with us simpler, we have developed a telehealth reference guide that provides direct links to helpful information around CMS and Humana’s coverage, reimbursement rules, requirements and program information for telehealth services provided through remote communication technologies. Included in the reference guide is easy-to-read guidance on telehealth billing for risk adjustment and Stars measures. Please refer to the telehealth reference guide and share it with your staff.
We encourage you to check humana.com/provider/coronavirus/telemedicine regularly for new information, such as the aforementioned telehealth reference guide, and for updates to benefits, expanded services, reimbursement changes and answers to the most frequently asked questions (FAQ) about telehealth policies. The FAQs continue to be updated as we re-evaluate our telehealth policy in light of the COVID-19 pandemic.
If there are additional ways we can support you and your healthcare organization, please contact your Humana representative.