Common Working File (CWF) Edits for Medicare Telehealth Services and Manual Update

CMS issued a new MLN Matters Article MM12068 on Common Working File (CWF) Edits for Medicare Telehealth Services and Manual Update (PDF). Learn about claims frequency for subsequent nursing facility care services.

Prior to 2021, for subsequent nursing facility care services, Medicare had limited the patient’s admitting physician or non-physician practitioner to one telehealth visit every 30 days. CMS is changing this limitation to once every 14 days (after the Public Health Emergency ends, which is not likely in 2021). Also, you may not furnish or report subsequent nursing facility care services for a Federally-mandated periodic visit under 42 CFR 483.40(c) through telehealth. The frequency limit of the benefit doesn’t apply to consulting physicians or practitioners, who should continue to report initial or follow-up inpatient telehealth consultations using the applicable HCPCS G-codes. For this edit change, CWF revises the current line-level edits from once every 30 days to allow a frequency of once every 14 days for the subsequent care codes (99307-99310) when billed with the GT or GQ modifier or Place of Service (POS) code 02, effective for claims with dates of service on or after January 1, 2021, that are processed on or after July 6, 2021.