CMS is Reprocessing Physician Telehealth Claims That Were Denied Due to SNF CB Edits

On July 31, 2020, in a late Special Edition of the MLN News, the Centers for Medicare and Medicaid Services (CMS) indicated that claims with dates of service on or after March 1, 2020, for physician telehealth services to Medicare Part A residents in a Skilled Nursing Facility (SNF) had been erroneously denied. The denials resulted from SNF Consolidated Billing (CB) edits that otherwise disallow these claims absent the broad COVID-19 Public Health Emergency (PHE) waivers. CMS reconfirmed that physicians can use CPT codes 99441, 99442, and 99443 (on the list of telehealth codes) during the COVID-19 PHE on Medicare Part B claims for telehealth services to Part A SNF residents.  CMS stated that physicians need not take any action to have these denied claims reprocessed, further stating that Medicare Administrative Contractors (MACs) are reprocessing these claims. CMS advised physicians who had already received payment from the SNF for these telehealth services to return such payments to the SNF once the MAC reprocesses the claim.

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