WEDI Brief Outlines Challenges to Telehealth Reimbursement
January 13, 2017
Healthcare providers face many challenges in launching and sustaining a telehealth program – including finding the right CPT codes, if they exist, for reimbursement.
In many cases, a telehealth or telemedicine procedure is so new, a proper definition and guidelines haven’t been written for it yet, the Workgroup for Electronic Data Interchange (WEDI) reports in a new issue brief. Without those definitions, payers won’t reimburse for the service - and if health systems aren’t getting paid for it, they likely won’t use it.
CPT (Current Procedural Terminology) code sets, part of the Healthcare Common Procedure Coding System (HCPCS), are maintained by the American Medical Association’s CPT Editorial Panel and used by the Centers for Medicare & Medicaid Services (CMS) for definition and reimbursement. With terms like telemedicine and telehealth entering the healthcare lexicon over the past two decades, the AMA has been slowly working to refine the codes to include new services. The organization even launched a 50-member Telehealth Services Workgroup in late 2015.
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