Telehealth Reimbursement Set at $99.45 for 2021

Updated 2/18/2021

After a delay and some initial confusion with the RVU file, CMS has confirmed and publicized the 2021 payment rate ($99.45) for G2025 services. This rate should apply to all G2025 services (telehealth visits) on or after January 1. An updated MLN Matters SE20016 is working its way through the approval process but CMS has publicized the rate here:

https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2021-02-18-mlnc#_Toc64450223

Original Article (1/29/2021)

According to a recently released Relative Value Unit (RVU) file, payment for RHC telehealth visits (G2025) appears to be falling from $92.03 in 2020 to $53.74 in 2021. The steep decline in reimbursement is mostly due to the complete removal of the Practice Expense RVU from G2025. 

It is unclear to us if this revaluation is simply an error or an incorrect read of the RVU files or a proactive policy decision. NARHC is already inquiring with CMS what happened here. As soon as we confirm some of these details, we will post an update to this article. 

In the CARES Act, a special payment rule was created for RHCs to be reimbursed for telehealth visits based on a “composite rate that is similar to the payment…for comparable telehealth services under the physician fee schedule.” 

Unless the Practice Expense RVU was similarly removed from physician fee schedule reimbursement for telehealth services (which does not appear to be the case), the drop to $53.74 would be in violation of the CARES Act. 

This also underscores why it is imperative that we pass some legislation such as the Ensuring Telehealth Expansion Act (H.R. 341) to address telehealth coding and reimbursement issues. 

Please check NARHC.org for updates.