Below are some of the most frequently asked questions CMA has received during the COVID-19 outbreak. By default, the most recent answers will appear up top. You can also filter the FAQ by category. We will update this resource regularly.
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Under a blanket waiver issued by the Centers for Medicare and Medicaid Services (CMS), Medicare will pay for hospital visits furnished via telehealth on an expanded basis. Previously, Medicare payment for telehealth was limited to designated rural areas and had limits on originating and distant sites. These limitations do not currently apply. Additionally, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during the public health emergency. Currently, there are no payment restrictions on distant site practitioners furnishing Medicare telehealth services from their home during the public health emergency. Likewise, hospital-based physicians may furnish telehealth services to patients who are at home.
Under the waiver, Medicare beneficiaries can receive a specific set of services through telehealth based on a list of approximately 80 codes; this includes certain CPT codes added during the public health emergency such as 99221-23 for initial hospital care and 99281-85 for an emergency department visit.
CMS is permitting the use of audio-only communication for a more limited set of codes. For any other services provided through telehealth, the physician must use an interactive audio-visual communication system. Physicians may continue doing e-visits and virtual check-ins with established patients in accordance with existing guidance. (See the CMS fact sheet for more information.).
Both the California Department of Health Care Services (DHCS) and the California Department of Managed Health Care (DMHC) permit physicians to bill plans for any telehealth services that the physician determines are clinically appropriate to provide through telehealth. According to the Medical Board of California, the standard of care is the same regardless of whether the service is provided in-person or via telehealth
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