O&P Included in Medicaid and Medicare Telehealth Services

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The Centers for Medicare & Medicaid Services (CMS) expanded the list of telehealth services that Medicare fee-for-service will pay for during the COVID-19 public health emergency (PHE), including O&P billing codes. O&P services are included as "Orthotic mgmt&traing 1st enc" and "Prosthetic traing 1st enc." They are classified as "Temporary Addition for the PHE for the COVID-19 Pandemic," with CPT billing codes 97760 and 97761, respectively.

CMS added 11 new services to the Medicare telehealth services list since the publication of the May 1 COVID-19 Interim Final Rule. Medicare will begin paying eligible practitioners who furnish these newly added telehealth services effective immediately, and for the duration of the PHE.

In the May 1 COVID-19 Interim Final Rule, CMS modified the process for adding or deleting services from the Medicare telehealth services list to allow for expedited consideration of additional telehealth services during the PHE outside of rulemaking. This update to the Medicare telehealth services list builds on the efforts CMS has already taken to increase Medicare beneficiaries' access to telehealth services during the COVID-19 PHE.

CMS is also providing additional support to state Medicaid and Children's Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth.

To further drive telehealth, CMS released a supplement to its State Medicaid & CHIP [Children's Health Insurance Program] Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version. It helps states identify services that can be accessed through telehealth, which providers may deliver those services, the ways providers may use in order to deliver services through telehealth, as well as the circumstances under which telehealth can be reimbursed once the PHE expires.

For the list of the added services, visit Covered Telehealth Services for PHE for the COVID-19 Pandemic on the CMS website.

To view the Medicaid and CHIP data snapshot on telehealth utilization during the PHE, visit the Medicaid website.