As healthcare regulations continue to evolve, practices need to stay ahead of the curve to ensure compliance and maintain revenue. Starting in 2024, Medicare will no longer cover CPT 95251 for telehealth services. This change impacts providers who rely on remote continuous glucose monitoring (CGM) interpretations for their patients.
How can practices adapt without sacrificing care quality or facing billing denials? Here are some strategies to help navigate this transition smoothly.
Why Is Medicare Removing CPT 95251 from Telehealth Coverage?
Medicare’s decision to remove CPT 95251 from telehealth billing is part of a broader effort to refine which services qualify for remote care. The focus is now shifting towards in-person services for CGM analysis, likely to reduce potential errors and ensure more accurate readings in a clinical setting.
While telehealth has been invaluable for many types of care, this change emphasizes the need for providers to reassess how they offer CGM services remotely and find compliant alternatives.
Adjusting Your Billing Protocols
Although CPT 95251 will no longer be available for telehealth billing, practices can still use it for in-person visits. For those heavily relying on this code for remote care, shifting patients back to in-office visits for CGM analysis can prevent disruptions in billing.
Alternative Codes to Consider
Several telehealth-friendly billing codes are still available, allowing you to continue offering quality care remotely while staying compliant. Consider the following options:
- G2010: This code covers remote evaluation of recorded videos/images and interpretation, which can be useful for quick evaluations related to CGM data.
- G0425-G0427: These codes are used for telehealth consultations, such as those in emergency or inpatient settings, and may be adapted for complex patient discussions.
- Modifier 25: If you’re providing evaluation and management (E/M) services along with CGM data analysis, use this modifier to bill for both services on the same day.
The Impact on Patient Care
Though this change may seem challenging, maintaining a seamless patient experience is essential. Clear communication about the need for in-office visits for CGM-related services will help patients understand the shift. Meanwhile, using alternative telehealth codes for other aspects of care can allow you to continue offering the convenience of remote services where appropriate.
Planning for a Smooth Transition
To ensure your practice is prepared:
- Review Current Processes: Identify patients being billed under CPT 95251 for telehealth and transition them to in-office visits.
- Update Staff Training: Ensure your billing and administrative teams are informed about the change and know how to utilize alternative telehealth codes.
- Communicate with Patients: Inform your patients about the Medicare changes and how their care will be affected. Offer flexible scheduling for in-person visits to minimize disruptions.
Conclusion
The removal of CPT 95251 from telehealth coverage in 2024 may require some adjustments, but with proactive planning, you can ensure a smooth transition while continuing to offer high-quality CGM services. Stay compliant and keep your practice running efficiently by adapting your billing and patient care strategies.
Have questions or need further guidance? Reach out to our team at MABS for support.
