June 17, 2021
With the State of California having recently lifted most of its COVID-19 restrictions, the California Medical Association (CMA) has begun to receive inquiries from physician practices asking if there are changes to telehealth payment parity coming soon, including whether the requirement to reimburse providers at in-office rates for telehealth services, including telephonic visits, may be ending.
According to the guidance from state regulators and the federal government, payors are required to continue with telehealth payment parity throughout the declared COVID-19 state of emergency or federal public health emergency, whichever is applicable (both of which still remain in effect) or until further notice from the regulator.
On June 15, 2021, Governor Newsom lifted most of the COVID-19 restrictions that had been in place, including most mask mandates for fully vaccinated people. However, the Governor has not lifted the state Public Health Emergency, so the telehealth orders remain in effect.
The federal Public Health Emergency was renewed in April and is in place until at least July 20, 2021. President Joe Biden has stated publicly that he expects the emergency declaration to remain in place through at least the end of 2021.
For more information, including details of the telehealth requirements currently in effect, see CMA’s COVID-19 Telehealth Toolkit for Medical Practices.
Patient Cost Sharing Waivers
Separate from payment parity for telehealth visits, during the state of emergency some payors voluntarily opted to waive patient cost sharing (e.g., copays, coinsurance, deductible) for telehealth services. CMA has heard that some payors are ending the voluntary waiver of patient cost sharing. However, physicians are reminded that for services provided via telehealth, a health plan may not subject enrollees to cost-sharing greater than it would have if the service were provided in person.
Billing for Audio-Only Telehealth Services
CMA has received several calls from physician practices concerned that commercial health plans are not reimbursing audio only services billed with CPT codes 99441-99443 (Telephone Services) at the same rate as in-person services.
With the exception of Medicare, the guidance generally instructs practices to bill for telehealth services, including audio only, as though the service was performed in the office with the appropriate in-office Evaluation and Management (E/M) code and appropriate modifier rather than billing with the Telephone Services CPT codes. The guidance does not require payors to reimburse Telephone Services codes at the same payment amount as in office E/M codes.
CMA encourages practices to review the detailed guidance from the various regulators that can be found in CMA’s COVID-19 Telehealth Toolkit for Medical Practices.
CMA Telehealth Advocacy
CMA has long-advocated—and continues to advocate—for increased access to telehealth services. In 2019, Governor Newsom signed a CMA-sponsored bill (AB 744) that requires health insurers to cover services provided via telehealth in the same way they would an in-person encounter. Under this new law, payor contracts issued, amended or renewed after January 1, 2021, must reimburse physicians for services delivered through telehealth services on the same basis and to the same extent that the payor reimburses for the same services provided in person.
This year, CMA and a broad coalition of health care providers and advocacy groups are also urging the legislature to pass AB 32 (Aguiar-Curry), which would make 3 important changes to California’s existing telehealth payment parity law. It would:
- Apply parity to rules to all payor contracts (not just those issued or renewed after January 1, 2021).
- Clarify that payment parity applies to audio-only telehealth.
- Clarify that, when health plans delegate to groups and IPAs, those entities must also comply with payment parity rules.
AB 32 passed out of the Assembly 78-0 and is currently awaiting action in the Senate Health Committee. If AB 32 passes, it will be a critical component of California’s telehealth policy infrastructure and would help pave the way for future health care innovation and advancement.
CMA is disheartened, however that the Governor continues to promote a policy that reimburses Medi-Cal providers for audio-only telehealth at only 65%, amounting to, essentially, a rate cut to physicians providing remote health care for Medi-Cal patients. Full reimbursement is currently available for Medi-Cal physicians for audio-only telehealth under the emergency COVID-19 regulations. CMA believes it is critical to retain this important tool in reducing health care disparities for Medi-Cal beneficiaries, and is working to oppose this policy.