FAIR Health Consumer Access

Telehealth and COVID-19

Telehealth is healthcare received through electronic devices, like telephones, tablets and computers. Its use has been growing in recent years. But it’s expected to grow even more in response to the COVID-19 pandemic.

Telehealth is important in the pandemic because the healthcare system is greatly strained taking care of all the patients sick with the new coronavirus. Telehealth offers a way for providers to treat more patients more efficiently. Another reason telehealth is especially useful now is that it doesn’t require in-person visits. Providers, their staffs and their patients take a risk of infecting each other when they meet in person. With telehealth, they don’t run that risk.

Because of the pandemic, regulations restricting telehealth have been relaxed. Private health plans have been expanding access. In two recent publications, FAIR Health studied telehealth. One publication is the third annual edition of our FH^® Healthcare Indicators and FH^® Medical Price Index white paper. The other is a brief on COVID-19. Both studies draw on our database of over 30 billion privately billed healthcare claim records. Here are some of our findings.

Growth
FAIR Health compared telehealth to other healthcare places of service such as urgent care centers and emergency rooms (ERs). Of five places of service we studied from 2017 to 2018, telehealth was one of two that grew in use. Telehealth use grew 12 percent and use of retail clinics grew 10 percent. But use of urgent care centers, ambulatory surgery centers (ASCs) and ERs all fell. Urgent care center use fell 11 percent, ASC use fell 12 percent and ER use fell 15 percent.

Limits
Despite its growth, telehealth hasn’t so far represented a large share of the healthcare market. From 2017 to 2018, telehealth’s percentage of medical claim lines increased slightly, from 0.11 percent to 0.12 percent. (Claim lines are the individual procedures or services listed on an insurance claim.) Still, the percentage in 2018 was small compared, for example, to that of ERs (2.22 percent).

Codes Most Often Used with Respiratory Infections
FAIR Health studied the top 10 telehealth codes most often associated with all respiratory infections in 2019. We did this because we assumed that these telehealth codes are likely to be used for COVID-19. The most commonly used code was CPT^®1 99441. That stands for a 5-10 minute telephone call with a physician or other qualified healthcare professional. The call is for evaluation and management (E&M), which is done to diagnose illness or to determine or manage treatment. This code was associated with half (50 percent) of all telehealth services for respiratory infections.

Costs for Telehealth
Some telehealth codes are used only for telehealth. They include 4 of the codes in the top 10 telehealth codes for respiratory infections. Among these four codes, the lowest costs are associated with the code just mentioned, CPT 99441. It has an average charge of $43 and an average estimated allowed amount of $34. Charges are the amounts billed to uninsured patients or those consulting an out-of-network provider. Allowed amounts are the amounts negotiated between a health plan and an in-network provider.

Other telehealth codes can be used for telehealth and other places of service. E&M codes billed both for telehealth and non-telehealth include 4 of the top 10 codes most often associated with respiratory infections. Among these codes, having telehealth as the place of service usually cuts costs by comparison with all places of service for the same code.

An example is CPT 99201, a 10-minute office or other outpatient visit for E&M of a new patient. The average charge across all places of service for CPT 99201 is $88. But the average telehealth charge for the same code is $55. The average estimated allowed amount across all places of service for this code is $47. The average telehealth estimated allowed amount is $45.

^{1 CPT © 2019 American Medical Association (AMA). All rights reserved.}