Expanding Physician Access with New Telehealth Codes

There will be 11 new CPT codes going into effect for telehealth in 2012.  I find the recent and rapid acceptance of telemedicine to be amazing.  CPT 99291 and 99292 (critical care, evaluation and management) have historically been used for physician payment of critically injured or ill patients.  Reimbursement averages almost $300 for 99291 and $130 for 99292, but prior to 2012, they required a face-to-face meeting between the physician and the patient.  In 2012, physicians will receive the same payment when they evaluate the patient via telehealth technologies.

So, what’s in it for the hospital?  One study indicated that telemedicine reduced the mortality rate of critical patients and reduced the length of stay by 1.26 days.  Furthermore, costs were also decreased over a five-year period from $7.6 million to $1.1 million, according to another study.

I asked Mr. Rob Sprang, project manager of Kentucky Telehealth Network in Lexington, Ky. about the impact of reimbursement.  He said, “Under the current reimbursement model, the payment is still quite limited as compared to hospital services.  The growth of the service is dependent on a combination of regulator advances and payment structures.  Now that traditional payment models are changing and new codes are being developed, we are seeing the market evolve.”

When I first wrote about telehealth in 2004, it was a $400 million market; the U.S. market is now projected to reach $3.6 billion by 2014 in part because of telehealth’s ability to assist with the shortage of specialty and primary care physicians in rural areas.  Now, with an expanding reimbursement structure, more hospitals will be able to take advantage of expert physicians.

James Laskaris, EE, BME
James Laskaris, EE, BME, Clinical Analyst — Mr. James Laskaris is a senior emerging technology analyst at MD Buyline and has been with the company since 1994. With over 30 years of experience in the healthcare field, Mr. Laskaris is the primary analyst of high-end OR technology. He also covers issues related to the legislative and reimbursement effect on healthcare and authors a bimonthly “Issues that Matter” publication. Mr. Laskaris received his biomedical engineering degree from Southern Illinois University. His work has been published in hfm Magazine, Radiology Manager and Healthcare Purchasing News.