Reimbursement codes for telemedicine in the works at AMA

By Jonah Comstock
An American Well video visit. An American Well video visit.

The American Medical Association has begun the process of creating a host of new CPT codes to support the reimbursement of telemedicine. A working group tasked with generating such a list met for the first time last week.

CPT stands for "Current Procedural Terminology" and the codes are used by healthcare providers and insurers to communicate the nature of services performed by providers. The codes are especially important for Medicare, which has strict guidelines on what it will and won't reimburse.

The new in 2015 CCM code is one gaining traction as a way to bill for telemedicine. And at present there are various CPT codes originallyintended for face-to-face encounters that can also be used for different telemedicine services, Modern Healthcare reports. But a set of standardized, explicit codes would go a long way toward making providers feel comfortable seeking reimbursement for virtual encounters, and some of them may even pay not just for the service, but the technology itself.

"The CPT code set is the foundation upon which every participant in the medical community -- physicians, hospitals, allied health professionals, payers and others -- can efficiently share accurate information about medical services," AMA President Dr. Steven J. Stack said in a statement. "Input from the Telehealth Services Workgroup will help the CPT code set reflect new technological and telehealth advancements available to mainstream clinical practice, and ensures the code set can fulfill its role as the health system's common language for reporting contemporary medical procedures."

The workgroup is comprised of about 50 physicians, health professionals, telemedicine innovators and health insurers who met last week in Philadelphia. Modern Healthcare reports positive momentum coming out of the first meeting, but a good deal more work to be done. Next, the workgroup will have to "sort itself into subgroups, get oriented to some future telehealth possibilities and triage the existing telemedicine use cases to determine those in most immediate need of codes and then produce code recommendations as soon as possible for the editorial board."

While the CPT Editorial Board is embracing telemedicine, other parts of the AMA have been more cautious. This summer the AMA's ethics council attempted to come to an agreement over a set of guidelines focused on ethical considerations related to the use of online or mobile visits between patients and physicians, but a physician from Texas helped convince the committee to rethink its plans. The guidelines were tabled and sent back to committee for further review. The earliest they could be floated again is November.