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  1. eCQM Issue Tracker
  2. CQM-7571

telehealth exclusions for CMS 22

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
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    • None
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    • Ashwini Mathai
    • 3474511040
    • Evidium / TJ Sampson
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      Thank you for your question related to CMS22v12. Telehealth encounters are not allowable for this measure and should not be captured in the initial patient population. In addition, value sets and specifications for eCQMs do not allow for CPT modifiers at this time; so, any qualifying encounter code (e.g., 99214) coded with a telehealth modifier should not be included in the initial population for the measure. Please continue to work with your EHR vendor to ensure these modified CPT codes are not included in the measure.
      Show
      Thank you for your question related to CMS22v12. Telehealth encounters are not allowable for this measure and should not be captured in the initial patient population. In addition, value sets and specifications for eCQMs do not allow for CPT modifiers at this time; so, any qualifying encounter code (e.g., 99214) coded with a telehealth modifier should not be included in the initial population for the measure. Please continue to work with your EHR vendor to ensure these modified CPT codes are not included in the measure.
    • CMS0022v13
    • CMS0022v12
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      Inaccurate collection of data due to value set oversight.
      We are at risk for submitting inaccurate data due to this issue. 
      Show
      Inaccurate collection of data due to value set oversight. We are at risk for submitting inaccurate data due to this issue. 

      CMS 22 has a telehealth exclusion criteria. Currently for our telehealth patients, we are using a CPT-4 99214, with a CDM number 99214TH with a CPT -4 modifer 95 as suggested by CMS. Our EHR provider and MIPS submission platform Cerner however is refusing to recognize these visits as telehealth visit because the the modified code in not represented in the value sets, only 99214.  This has resulted in telehealth visits incorrectly categorized. 

       

      What would you suggest as a work around for this issue. We are at risk for submitting inaccurate data due to this issue. 

       

       

       

       

            AIR EC eCQM Team AIR EC eCQM Team
            Ashmath Ashwini
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