AMA Lobbies CMS to Extend Medicare Coverage for Audio-Only Telehealth

The American Medical Association has sent a letter urging CMS to permanently extend Medicare coverage for audio-only telehealth services. Separately, CMS is being urged to include virtual care in the Medicare Diabetes Prevention Program.

The American Medical Association is lobbying for permanent Medicare coverage for audio-only telehealth services.

In a letter to Acting Centers for Medicare & Medicaid Services Administrator Elizabeth Richter, AMA Executive Vice President and CEO James Madara, MD, urged the agency to continue coverage for phone calls beyond the public health emergency caused by the coronavirus pandemic.

CMS and many states have allowed that coverage during the PHE to boost access to care at a time when providers are looking to replace in-person visits with virtual visits. For the duration of the PHA, Medicare coverage is based on CPT codes 99441-3 and HCPCS code G2252.

“Payment for audio-only visits has been a lifeline for patients during the COVID-19 PHE,” Madara said, adding that the AMA would develop permanent CPT codes in time. “The need for these services to be available will not diminish when the PHE ends, and the AMA strongly urges CMS to continue separate payment for the CPT codes in the future.”

Connected health advocates say the audio-only telehealth platform, such as a phone or laptop connection, may be the only means of access to healthcare for people in remote areas where broadband connectivity is limited and those with limited resources who can’t afford audio-visual telemedicine tools.

Opponents say the platform isn’t good enough for many healthcare service or to establish a good doctor-patient relationship.

“Discontinuing payment for these services would exacerbate inequities in health care, particularly for those who lack access to audio-video capable devices such as seniors in minority communities that have been devastated by COVID-19,” Madara said in the letter.

“Many of the same patients who cannot access audio-video telehealth services also face barriers to accessing timely in-person services,” he pointed out. “The decision about whether an in-person office visit is needed is very different for a patient in a rural area who may have to travel for hours to reach their physician’s office than for patients who are located close to the medical practice and do not face barriers such as functional limitations. Similarly, the decision about whether a patient should continue to try and stabilize an acute problem at home or travel to a distant emergency department is a more complicated decision without access to timely in-person care or audio-video telehealth services. The availability of timely audio-only services has made a huge difference to these patients and their physicians.”

Federal officials are also being pressed to include coverage for telehealth services in the Medicare Diabetes Prevention Program.

More than 20 organizations, including the American Telemedicine Association, Blue Cross Blue Shield Association, eHealth Initiative, National Kidney Foundation and Diabetes Leadership Council, have signed a letter asked Health and Human Services Secretary Xavier Becerra to extend Medicare coverage for virtual visits during the PHE and “work on longer-term reforms” that would make connected health a permanent part of the program.

The letter, drafted by the Alliance for Connected Care, was sent to Becerra this week. It notes that roughly 88 million people, or one in every three Americans, has prediabetes, and could develop the chronic disease if not given health and wellness resources and coaching.

“Given the ongoing and worsening prediabetes challenges facing seniors, expectations that the PHE will continue throughout 2021, and the cessation of many in-person DPP programs, we believe CMS must act immediately to preserve access to these services,” the letter says. “We believe that the Department of Health and Human Services should immediately use its emergency authority to remove in-person requirements from Medicare DPP services for the remainder of the COVID-19 PHE. We then strongly recommend that data from this expansion be leveraged to evaluate the merits of expanding virtual MDPP services permanently.”

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