Virtual Care


Under the 2019 proposed Medicare Physician Fee Schedule, Medicare (CMS) is now considering payment for virtual care visits (brief technology-based communication).

Virtual Care Blog Image

  • CMS recognizes that care is changing with the times, and the traditional office visit, is changing with technology. Non-face-to-face work, plus changes in communication technology have redefined the patient/provider relationship
  • Proposed, is a new G code (GVCI1), loosely based on an existing non-covered CPT Code 99441 (phone E/M PHYS/QHP 5-10 min). Under the new G code, it is being described as a virtual check-in (via physician/other qualified health care professional) who can report evaluation and management:
    • Provided to an established patient
    • Does not originate from a related E/M service provided within the last 7 days
    • Does not lead to an E/M visit within the next 24 hours (or soonest available apt)
  • The caregiver setting, would most likely be consistent with the existing Telehealth Distant site location policy, but would also include Rural Health Clinics (RHCs) and federally qualified health care centers (FQHCs) settings
  • This proposed change (when finalized), will be applicable to traditional Medicare only. Varying degrees of adoption will occur with Medicaid and other non-governmental carriers (including Medicare Advantage plans)
  • If approved, the new virtual care visits would be effective Jan 1, 2019. In addition, pricing for the new service will be lower than that of an E/M in-person visit.

Final regulations regarding the possible change will be available no later than Nov 1, 2018. Please note this proposal is not to be confused with Medicare’s Telehealth program and reimbursement policy. Distinct differences to that program do exist.

Lastly, it is never too late to be operationally ready for such changes. Under this proposal, Medicare anticipates this action will mitigate the need for potentially unnecessary office visits (and fewer billable services).

About the Author:

Kerry Luciani, Business Intelligence Manager for Healthcare Resource Group, Inc.

Kerry has over 30 years of healthcare revenue cycle management experience on both the payer and provider side. Over the course of his career, Kerry has developed an abundance of expertise in Medicare Part B reimbursement and has published several comments in the Federal Register.

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