Gaps in the Coding Infrastructure Limit Innovation of Virtual Care Services
The growth in use and availability of virtual care services has expanded access for individuals, especially for those without a regular source of care. The medical coding infrastructure should be updated and modernized to incorporate these new modalities.
National standardized code sets are used to report medical diagnoses, tests, services, and procedures on healthcare claims. The Current Procedural Terminology (CPT) code set is maintained by the American Medical Association and used to report services delivered by physicians and other providers. Coding systems evolved quickly to keep pace with innovations and flexibilities adopted during the COVID-19 pandemic. However, this analysis conducted by HMA and funded by the Elevance Health Public Policy Institute shows that further expansion of the code sets is warranted.
In particular, gaps could be addressed in two ways. Create a set of time-based e-visit codes for patients without an existing provider relationship and add a unique modifier code to report that care was rendered via secure short messaging services (SMS) communication.
Related Public Policy Research
Telehealth Utilization in Florida Medicaid from 2019 to 2021 Underscores Opportunity to Improve Access
In response to COVID-19 and the public health emergency that ensued, Medicaid allowed reimbursement for a broader range of telehealth services, resulting in major increases in utilization. Telehealth utilization in Florida Medicaid has persisted past the peaks of the pandemic, with higher utilization among rural members, older adults, and minority communities. As federal policymakers and state Medicaid agencies consider the future of telehealth policy, it is important to consider how telehealth services can impact Florida’s diverse Medicaid population.
Advancing Interoperability Requires Close Collaboration between Plans and Providers
A fully interoperable healthcare system would allow providers, consumers, and health plans to share and integrate data across medical records and systems. Despite new regulatory requirements, significant amounts of clinical data remain inaccessible or fragmented.
Virtual Healthcare Use Among Medicare Advantage Members Before and During the COVID-19 Pandemic
Virtual care among Medicare Advantage enrollees grew exponentially in the early months of the COVID-19 pandemic. Use varied across demographic groups, though, including older individuals.