The Evolution of Telehealth during the
COVID-19 Pandemic

A Multiyear Retrospective of FAIR Health's Monthly Telehealth
Regional Tracker

A FAIR Health Brief, June 14, 2022

 

Health

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Copyright 2022, FAIR Health, Inc. All rights reserved.
Summary

Since the spring of 2020, the national, independent nonprofit FAIR Health has tracked month-to-month
changes in telehealth utilization with its Monthly Telehealth Regional Tracker. Using FAIR Health's
comprehensive collection of telehealth data, this free, online tool has shed light on telehealth's evolving
role in the healthcare system and provided a greater understanding of telehealth utilization throughout the
COVID-19 pandemic.

To further illuminate telehealth's growth, this brief provides a multiyear retrospective of the findings made
available through the Monthly Telehealth Regional Tracker. Focusing on the period from January 2020 to
March 2022, it reports on monthly changes in telehealth's utilization, top diagnoses and top procedure
codes-in addition to other descriptive aspects of this venue of care-at national and regional levels.
Supported by infographics with vivid data visualizations, the brief also shows how the Telehealth Tracker
itself has evolved: focusing in the first year on a comparison of telehealth in 2019 versus 2020; changing
in 2021 to an emphasis on month-to-month fluctuations; and adding new features in 2022, such as a
Telehealth Cost Corner, in which cost information for a specific telehealth procedure code is presented.

Among the key findings:

e From March 2019 to March 2020, the percentage of national telehealth claim lines when
compared to all medical services increased 4,347 percent.' The increase was even greater from
April 2019 to April 2020 (8,336 percent).

e The top five telehealth diagnoses nationally in spring 2020 indicated that telehealth was being
used for conditions that had not been among the top five the year before, including hypertension,
joint/soft tissue diseases and issues, and developmental disorders.

e In November 2020, COVID-19 appeared for the first time on one of the regional lists of top five
telehealth diagnoses, ranking fourth in the Midwest; in December 2020, COVID-19 emerged as a
top telehealth diagnosis nationally and in every region.

e For 6 of the 12 months of 2021, telehealth utilization fell from the level of utilization in the prior
month. Nevertheless, it remained much higher than before the pandemic. In December 2021,
telehealth claim lines accounted for 4.9 percent of medical claim lines nationally, compared to 0.2
percent in December 2019.

e Many changes in telehealth utilization were likely related to the course of the pandemic. For
example, in spring and summer 2021, telehealth claim lines dropped as vaccination levels
increased. In fall and winter 2021, however, telehealth utilization rose again as the Delta and
Omicron variants led to increased COVID-19 cases.

e Mental health conditions have been the most common telehealth diagnosis nationally throughout
the pandemic. Consistent with that finding, in January 2022, social worker was the provider
specialty rendering the most telehealth services (most commonly psychotherapy) nationally and
in every region but the West. In every region, as in the nation as a whole, three of the top five
provider specialties were related to mental health: social worker, psychiatrist and psychologist.

e In January 2022, CPT®2 90837, one hour of psychotherapy, ranked highest among telehealth
procedure codes nationally and in every region.

 

1 A claim line is an individual service or procedure listed on an insurance claim.
2 CPT © 2021 American Medical Association (AMA). All rights reserved.

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Background

Telehealth, the remote delivery of clinical services via telecommunications technology, readily connects
patients with providers outside of traditional care settings. Since the onset of the COVID-19 pandemic,
telehealth has undergone notable growth. Starting in the spring of 2020, FAIR Health's Monthly
Telehealth Regional Tracker has monitored the evolution of telehealth on a monthly basis, providing a
clear and reliable analysis of its changing contours to key stakeholders across the healthcare continuum.

Drawing on the nation's largest repository of private healthcare claims, the Monthly Telehealth Regional
Tracker is a free, interactive map of the four US census regions, which allows users to view an
infographic on telehealth in a specific month in the nation as a whole or in individual regions (Midwest,
Northeast, South and West). While monitoring the changes in this venue of care, the Telehealth Tracker
itself has evolved with new features and analytics. Each iteration of the Telehealth Tracker has been
adjusted to reflect the evolving needs of stakeholders:

e Monthly Telehealth Regional Tracker 1.0 (2020): In the Telehealth Tracker's first year, to study
the initial impact of the COVID-19 pandemic on telehealth, each month in 2020 was compared to
the corresponding month in 2019. Data fields evaluated included telehealth's volume of claim
lines, urban versus rural usage, top five procedure codes and top five diagnoses.

e Monthly Telehealth Regional Tracker 2.0 (2021): In the Telehealth Tracker's second year, the
focus turned to monthly rather than year-over-year changes. Data fields evaluated included
telehealth's volume of claim lines, top five procedure codes, top five diagnoses and top five
mental health diagnoses.

e Monthly Telehealth Regional Tracker 3.0 (2022): In the Telehealth Tracker's third year, each
infographic continues to show telehealth's month-to-month changes. Data fields evaluated
include telehealth's volume of claim lines, top five procedure codes, top five diagnoses and top
five specialties. Additionally, the Telehealth Cost Corner features the median charge amount? and
median allowed amount? for a specific telehealth procedure code.

The Telehealth Tracker has become a mirror reflecting the cycles of the pandemic, and as a result,
relevant and actionable to all stakeholders. Plans use it to inform reimbursement and/or networking
decisions, hospitals to identify potential affiliation arrangements, consultants to advise on investment
opportunities, tech companies to understand what kinds of new asynchronous telehealth technologies are
worthy of investment, and researchers to better understand patient migratory patterns and the evolving
nature of the healthcare system. The Telehealth Tracker has likewise attracted the interest of federal
agencies and policy makers, including the Health Resources & Services Administration (the Office for the
Advancement of Telehealth and the Federal Office of Rural Health Policy), the Senate Finance
Committee, the National Cancer Institute and the Centers for Disease Control and Prevention (CDC)-
many of whom have used FAIR Health's findings to inform proposed legislation and regulation related to
telehealth's role in the healthcare system.

Methodology

To create the Monthly Telehealth Regional Tracker, FAIR Health uses data from its repository of billions
of private healthcare claim records, which represents the privately insured population, including Medicare
Advantage and excluding Medicare Fee-for-Service and Medicaid.

FAIR Health applies several methodologies to segregate claims for telehealth services, including using
the Centers for Medicare & Medicaid Services (CMS) place of service codes for telehealth (02 or 10),

 

3 The charge amount is the amount charged to a patient who is uninsured or obtaining out-of-network service.
4 The allowed amount is the total fee negotiated between an insurance plan and a provider for an in-network service.
It includes both the portion to be paid by the plan member and the portion to be paid by the plan.

Health The Evolution of Telehealth during the COVID-19 Pandemic K}
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telehealth-only CPT codes such as CPT 99441 (physician or other qualified healthcare professional
telephone evaluation, 5-10 minutes) or telehealth modifiers (GT, GQ, FQ, FR, 93 or 95).

The data are aggregated by a variety of key fields, including region, rural/urban, diagnostic categories
and month/year of service, to identify trends and pattens in utilization. Regional aggregation is based on
the four US census regions:

e Midwest: Illinois, Indiana, lowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North
Dakota, Ohio, South Dakota, Wisconsin;

e Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York,
Pennsylvania, Rhode Island, Vermont;

e South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky,
Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas,
Virginia, West Virginia; and

e West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico,
Oregon, Utah, Washington, Wyoming.

Telehealth utilization is measured by telehealth's share of all medical claim lines. To normalize the data
and avoid fluctuations due to natural changes within plan data (e.g., the closing of a major retailer and the
loss of those members, or the addition of a major employer to a plan from which FAIR Health receives
data, which would create a net influx of data from those members), FAIR Health calculates each data
point as a percentage of the total number of medical claim lines for each month. When evaluating
telehealth utilization, the number of telehealth services (telehealth claim lines) is the numerator and the
number of overall medical services (all medical claim lines) is the denominator.

To calculate costs for the Telehealth Cost Corner, FAIR Health uses 2021 data from its FH® Telehealth
and FH® Allowed Telehealth benchmarks.

Limitations

The data used in this report comprise claims data for privately insured patients who are covered by
insurers and third-party administrators who voluntarily participate in FAIR Health's data contribution
program. Medicare Advantage (Medicare Part C) enrollees from contributing insurers are included, but
not participants in Medicare Parts A, B and D.5 In addition, data from Medicaid, CHIP and other state and
local government insurance programs are not included, nor are data collected regarding uninsured
patients.

This is an observational report based on the data FAIR Health receives from private payors regarding
care rendered to covered patients.

The report was not subject to peer review.

 

5 FAIR Health, as a CMS-certified national Qualified Entity, receives the entire collection of claims for traditional
Medicare Parts A, B and D under the CMS Qualified Entity Program, but those data are not a source for this report.

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Findings

Monthly Telehealth Regional Tracker 1.0 (2020)

The original iteration of the Telehealth Tracker, launched in May 2020, compared a month in 2020 with its
corresponding month in 2019 to show the dynamic changes associated with virtual visits before and after
the onset of the COVID-19 pandemic.

Each infographic included findings on the volume of telehealth claim lines, urban versus rural usage, the
top five telehealth procedure codes and the top five telehealth diagnoses.

Winter 2020

In January 2020, telehealth accounted for 0.24 percent of all medical claim lines nationally (figure 1). This
was a 43 percent increase from the same month the year before, revealing that telehealth utilization was
on the rise prior to the onset of the COVID-19 pandemic. Telehealth's volume of medical claim lines
varied throughout the four US census regions, making up the smallest share of claim lines in the
Northeast at 0.09 percent and the largest share in the South at 0.41 percent. Throughout the United
States, urban locations saw higher rates of telehealth services than rural ones, except in the Midwest,
where telehealth captured 0.12 percent of medical claim lines in urban areas and 0.16 percent in rural

areas.

 

   

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Figure 1. Monthly Telehealth Regional Tracker: January 2020, United States

 

Analysis of CPT codes in the United States and all four regions revealed that evaluation and
management (E&M) visits (such as CPT 99213, 15-minute established patient office or other outpatient
visit) and telephone services of varying lengths (such as CPT 99441, 5-10 minute physician telephone
patient service) were among the top five procedures conducted via telehealth in both January 2020 and
2019. Also included on the national list in January 2019 and January 2020 was CPT 98960, 30-minute
education and training for patient self-management (figure 1). Notably, the Northeast was the only region

Health The Evolution of Telehealth during the COVID-19 Pandemic 5
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with a psychotherapy visit (CPT 90834) included among the top five telehealth procedures in January
2020, prior to the beginning of the pandemic.

The top telehealth diagnoses (or diagnostic categories) were similar nationally and in each region for both
January 2019 and January 2020. Mental health conditions, acute respiratory diseases and infections,
influenza and pneumonia, urinary tract infections, and eye infections and issues made up the top five
telehealth diagnoses nationally (figure 1) and in the Midwest and South. In the Northeast, skin infections
and issues ranked among the top five, while eye infections and issues did not. The West differed the most
from the other regions, with encounter for procreative or contraceptive management and joint/soft tissue
diseases and issues appearing in its list. In every region except for the South, mental health conditions
were the number one telehealth diagnosis; in the South, acute respiratory diseases and infections were
the most common diagnosis.

In February 2020, telehealth claim lines accounted for 0.38 percent of all medical claim lines, a 121
percent increase from the same month the year before. Each region's volume of claim lines was higher in
February 2020 than it was in February 2019, except for the Midwest, where telehealth utilization
decreased four percent year to year.

Similar to January, the top telehealth procedure codes in February 2019 and February 2020 were largely
E&M visits and telephone services of varying lengths nationally and in all regions. In the Midwest,
however, CPT 90837 (60-minute psychotherapy) and CPT 90834 (45-minute psychotherapy) ranked as
number three and five, respectively, in the list of top procedure codes in February 2020. The same codes
also appeared on the list in the Northeast, with CPT 90834 ranking as second and CPT 90837 ranking as
third in February 2020. CPT 90834 was also among the top procedure codes in the Northeast in February
2019.

The top telehealth diagnoses in February 2019 and 2020 were similar to those in January, though the
Northeast saw some notable differences. In the Northeast, urinary tract infections and influenza and
pneumonia no longer ranked among the top five in February 2020, as they had in February 2019 (as well
as January 2020); general signs and symptoms and joint/soft tissue diseases and issues took their
positions.

Health The Evolution of Telehealth during the COVID-19 Pandemic 6
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Spring 2020

During the spring 2020 wave of the COVID-19 pandemic, telehealth grew markedly. Telehealth claim
lines as a share of all medical claim lines increased 4,347 percent nationally, from 0.17 percent of
medical claim lines in March 2019 to 7.52 percent in March 2020. In an indication that the growth was
related to the COVID-19 pandemic, the increase was even more pronounced (15,503 percent) in the
Northeast, where the pandemic hit hardest in March (figure 2).

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Figure 2. Monthly Telehealth Regional Tracker: March 2020, Northeast

Telehealth reduced the risk of COVID-19 transmission associated with in-person visits. For that reason,
patients and providers turned to it, federal and state regulations related to telehealth were somewhat
relaxed,® and private payors expanded access to telehealth. In addition, widespread restrictions on
elective in-person procedures made telehealth a viable option.

 

§ Gabriela Weigel et al., "Opportunities and Barriers for Telemedicine in the U.S. during the COVID-19 Emergency
and Beyond," KFF, May 11, 2020, https:/Awww.kif.org/womens-health-policy/issue-brief/opportunities-and-barriers-for-
telemedicine-in-the-u-s-during-the-covid-19-emergency-and-beyond/.

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In April 2020, when those restrictions continued in much of the country, telehealth grew even more
sharply. Telehealth's share of all medical claim lines increased 8,336 percent nationally, from 0.15
percent of medical claim lines in April 2019 to 13 percent in April 2020 (figure 3). In each region, the
increase from April 2019 to April 2020 was greater than from March 2019 to March 2020.

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Figure 3. Monthly Telehealth Regional Tracker: April 2020, United States

 

In March and April 2020, established patient E&M services and psychotherapy visits of varying lengths
dominated the lists of top procedures rendered via telehealth. Telephone services, such as CPT 99441
(5-10 minute telephone service) and CPT 99442 (11-20 minute telephone service), became less frequent,
and by April, they had dropped to the bottom of the top five procedure codes nationally (figure 3) and in
every region except for the West, where they fell off the list entirely.

Nationally and in all regions, the top five telehealth diagnoses that spring indicated that telehealth was
being used for conditions that had not been among the top five the year before-such as hypertension,
diabetes mellitus, joint/soft tissue diseases and issues and developmental disorders. Mental health
conditions, which became the number one telehealth diagnosis nationally and in every region in March
2020, accounted for an even larger share of telehealth claim lines by May 2020, increasing from 33.91
percent of telehealth claim lines nationally in March 2020 to 39.56 percent in May 2020.

After the first months of the pandemic, many of the restrictions on elective in-person care expired in May
2020. Telehealth had another large year-to-year increase-its share of medical claim lines increased
5,680 percent nationally, from 0.15 percent of medical claim lines in May 2019 to 8.69 percent in May
2020-but the increase was not as large as it was from April 2019 to April 2020. On a month-to-month
basis, telehealth claim lines as a percentage of all medical claim lines fell 33 percent nationally from April
to May 2020. Nevertheless, the pandemic continued and telehealth usage remained high in comparison
with 2019.

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Summer 2020

In the summer months of June to August 2020, telehealth continued to have large year-to-year
increases-smaller than during the spring wave, but substantial enough to suggest telehealth's staying
power. For example, telehealth's share of medical claim lines increased 4,131 percent nationally from
June 2019 to June 2020, rising from 0.16 percent of medical claim lines in June 2019 to 6.85 percent in
June 2020.

However, at the beginning of the summer, in each region and nationally, there was a small decline in the
volume of telehealth claim lines from month to month. While increasing notably from 2019 to 2020,
telehealth's share of medical claim lines fell 12 percent nationally, from 6.85 percent of medical claim
lines in June 2020 to 6 percent in July 2020. In August, there were month-to-month variations somewhat
commensurate with changes in the pandemic-for example, telehealth's share of medical claim lines rose
the most (9.7 percent) in the South, which was particularly hard-hit in the summer; it fell the most (7.7
percent) in the Northeast, which had experienced its peak of cases that year in the spring.

Throughout the summer, urban utilization of telehealth services continued to outdistance rural utilization
nationally and in every region. From June to August 2020, telehealth captured between 7.29 and 6.36
percent of medical claim lines in urban areas, respectively, and only 3.05 to 3.45 percent in rural areas,
respectively. This trend of higher utilization rates in urban areas, as compared to rural areas, persisted
through the rest of the year.

Although the top procedures conducted via telehealth largely remained the same from spring through
summer 2020-consisting of E&M services, psychotherapy visits and short telephone services-the top
telehealth diagnoses continued to diversify. In June 2020, exposure to communicable diseases became
the fifth most common diagnosis in the South and West, which was likely a result of patients contacting
providers via telehealth out of concern they had been exposed to COVID-19. Notably, in July 2020,
substance use disorders emerged as one of the top five telehealth diagnoses in the Northeast, where it
ranked fifth. This is consistent with an increase in substance use disorders that was reported during the
COVID-19 pandemic by the CDC' and others.

 

7 Mike E. Czeisler et al., "Mental Health, Substance Use, and Suicidal Ideation during the COVID-19 Pandemic -
United States, June 24-30, 2020," Morbidity and Mortality Weekly Report 69, no. 32 (August 14, 2020): 1049-57,
https:/Awww.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm.

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Mental health conditions continued to rise as a share of all telehealth diagnoses during the summer,
growing nationally from 45.39 percent to 48.93 percent from July to August 2020. During that same
period, acute respiratory diseases and infections rose from the fifth most common diagnosis in telehealth
nationally (at 2.37 percent) to the fourth most common (at 2.32 percent). Even so, acute respiratory
diseases and infections accounted for a much smaller share of telehealth claim lines in August 2020 than
they did in August 2019 (17.63 percent; figure 4), due to the diversity of other diagnoses that became
more common in telehealth as a result of the pandemic.

Monthly Telehealth Regional Tracker, Aug. 2020

 

 

     

 

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Figure 4. Monthly Telehealth Regional Tracker: August 2020, United States

 

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Fall 2020

At the beginning of fall 2020, telehealth maintained its pattern of marked, though declining, increases in
utilization compared to the year before. Telehealth's share of medical claim lines increased 2,980 percent
nationally from September 2019 to September 2020, rising from 0.16 percent of all medical claim lines in
September 2019 to 5.07 percent in September 2020. From month to month, telehealth's share of medical
claim lines fell 16.5 percent nationally, from 6.07 percent in August 2020 to 5.07 percent in September
2020. The following month, however, telehealth claim lines' share rose 10.6 percent nationally, coinciding
with a surge in COVID-19 cases beginning in October 2020 (figure 5). There were sizable year-to-year
and smaller month-to-month increases in each region as well. Month-to-month growth continued in
November nationally and in all regions but the South.

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Sourcw: FH MPSS? database of mone tham 3? biti ely Side! eomctical an ds from more than 60 conics tioweide Coppright 2021 FAIR Healt inex AB nghis reserved CPT © 2020 American Wecical Association (AMA) Al nights nesencend

 

 

a CS ue ee MCI Ne ele eee el Ke Mm Ue PE uct ge

Figure 5. Monthly Telehealth Regional Tracker: October 2020, United States

The rising number of COVID-19 cases in the late fall of 2020 brought notable changes to the top five
telehealth diagnoses by volume. In October 2020, exposure to communicable diseases joined the
rankings nationally (figure 5) and in every region. As a result, different diagnoses fell out of the lists in
different regions, such as substance use disorders in the Northeast and hypertension in the South.

Health The Evolution of Telehealth during the COVID-19 Pandemic

Know Your Source

 
By November 2020, exposure to communicable diseases was number two on the national list of
telehealth diagnoses and rose in the rankings in all regions except the Midwest, where it stayed at
number three, the same as the previous month. Also in November 2020, COVID-19 appeared for the first
time on one of the regional lists of top five telehealth diagnoses, ranking fourth in the Midwest (figure 6).

Monthly Telehealth Regional Tracker, Nov. 2020

 

 

    

 

 

 

        

 

Pa Ce a Ce een a ee AR
Top Five Procedure Codes by Utilization, 2019 vs. 2020 (©) votume of Claim Lines, 2019 vs. 2020
Jn order from mast to east common
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see MANAGENENT OF PATIENT CARE BY INTERNET (EMAIL) RELATED T0 S08: PSYCMOTHERAPY 60 MINUTES: =
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sonar AND WANIAGEMENT SERVICE BY QUALIFIED HIS-PHYSICOAN fodas PHYSICIAN TELEPHONE PATIENT SERVICE, 11-20 MINUTES OF Ain e
HEALTHCARE PROFESSIONAL MEDICAL DFSGU5S00N Nov. 20419 Now. 2020
@ Top Five Diagnoses, 2019 vs. 2020 @ Urban vs. Rural Usage, 2019 vs. 2020
Nov. 2019 2 Nov. 2020
= Gry Math z
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Figure 6. Monthly Telehealth Regional Tracker: November 2020, Midwest

 

Although mental health conditions remained the number one telehealth diagnosis nationally and in every
region, its percentage of telehealth claim lines fell, perhaps as a result of an increase in COVID-19-
related visits. Nationally, mental health conditions decreased from 51.81 percent of telehealth claim lines
in October 2020 (figure 5) to 48.17 percent in November 2020. Telehealth nonetheless remained a
leading venue for the delivery of mental health services, which is apparent in the rankings of top
telehealth procedure codes. In September and October 2020, CPT 90834 (45-minute psychotherapy) and
CPT 90837 (60-minute psychotherapy) rose to numbers one and two, respectively, on the list of the top
telehealth procedure codes in the Northeast. In October and November 2020, CPT 90837 was also the
most common telehealth service in the Midwest (figure 6).

Health The Evolution of Telehealth during the COVID-19 Pandemic

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Telehealth utilization as a percentage of all medical claim lines increased 2,817 percent nationally from
December 2019 to December 2020, rising from 0.22 percent in December 2019 to 6.51 percent in
December 2020 (figure 7). On a month-to-month basis, telehealth's share of claim lines rose 8.3 percent
nationally from November to December 2020. In each region, there were sizable percent increases in the
volume of telehealth claim lines from December 2019 to December 2020; smaller increases occurred
from November to December 2020 in every region but the Midwest.

Monthly Telehealth Regional Tracker, Dec. 2020

 

  

LAs cs TT Ret
Top Five Procedure Codes by Utilization, 2019 vs. 2020 a) Volume of Claim Lines, 2019 vs. 2020
Jn order fram mast to feast common
Dec. 2019 Dec. 2020
2
cous PHYSICIAN TELEPHONE PATIENT SERVICE, $10 MINUTES OF MEDICAL 9743 ESTABLISHED PATIENT OFFICE OR OTHER CHITPATIENT VESIT
DSSCUSSION TYPICALLY 15 MINUTES 4
Eerall Gem ee ee VEST TYPICALLY 10 agg? DEY CHOTHERAPY 60 MINUTES 3 .
gota ESTASUSHED PATIENT OF RICE OR OTHER OUTPATIENT VISIT, gata ESTABLESHED PATIENT OFFICE OR ONHER OUTPATIENT VESIT = 1
TYPICALLY 1 MANLITES: TYPICALLY 25 MINUTES 2 3
PHYSICIAN TELEPHONE PATIENT SERVICE, 11.20: MINUTES OF i = a ae
'goa ee soe PSYCHOTHERAPY. 45 UNITES 3 p2a%
78D EDGCATION AND TRAINING FOR PATIENT SELFABNAGCVENT EACH 0841 PHYSICIAN TELEPHONE PATIENT SERVICE. 5-00 MNUTES GF = 0% -_--
SO MINUTES. MEDICAL DESCUSS1ON oryars n _
Dee 2019 Dee: 2020
@ Top Five Diagnoses, 2019 vs. 2020 as Urban vs. Rural Usage, 2019 vs. 2020
Dec, 2019 2 Dec. 2020
3
B 4
Ss FR
5 1.28%. 9. pps
e ?

 

Dec. 2019
gm Urban im Ruret

 

Source: PH NPAC 22 tlio prtcabey bat rnc than G0) corti 'Coppight 7027, FAR Heath, inc Ad nights seserved. CPT G 2021) Amercan Waedcal Assccialion |AMMA|. Ad rights nesoraed.

fairhealth.org | fairhealthconsumer.org | fairhealthconsumidor.ong | 855-301-FAIR (3247) | info@fairhealth.org

Figure 7. Monthly Telehealth Regional Tracker: December 2020, United States

 

COVID-19, for the first time, became one of the top five telehealth diagnoses nationally (figure 7) and in
every region in December 2020. Its prominence may have reflected the surging number of COVID-19
cases and relatively fewer telehealth visits for other conditions, such as the flu, cases of which were
unusually low® that season. Mental health conditions continued to be the number one telehealth diagnosis
nationally and in every region. Exposure to communicable diseases continued to be number two on the
national list of telehealth diagnoses (figure 7) and to appear in the top five in all regions.

Also notable in December was the lack of change in the top five procedure codes by utilization. There
were no changes nationally or by region from November to December 2020 in the top procedure codes,
even though there had been changes in at least some regions in previous months. This suggests that the
telehealth procedures being performed might have stabilized by December.

 

8 Julia Ries, "While COVID-19 Is Raging, Flu Cases Remain Unusually Low," Healthline, January 7, 2021,
https://Awww.healthline.com/health-news/while-covid-19-is-raging-flu-cases-remain-unusually-low.

Health The Evolution of Telehealth during the COVID-19 Pandemic

Know Your Source

 
Monthly Telehealth Regional Tracker 2.0 (2021)

A year after launching the Telehealth Tracker, FAIR Health enhanced the tool to offer additional insights
into telehealth's evolution. Rather than comparing the same month across years (2019 versus 2020), the
updated Telehealth Tracker offered a month-to-month comparison to help stakeholders obtain a better
understanding of whether the increases in telehealth utilization that occurred during the initial onset of the
pandemic continued, plateaued, changed in substance or decreased in 2021.

The data fields evaluated in the 2021 Telehealth Tracker included telehealth's volume of claim lines, top
five procedure codes, top diagnoses and top mental health diagnoses.

Winter 2021

As the COVID-19 pandemic entered its second year, utilization of telehealth continued to grow nationally
and in every region. Telehealth's share of medical claim lines increased nationally 7.69 percent, rising
from 6.5 percent of medical claim lines in December 2020 to 7 percent in January 2021. Telehealth's
continued growth can likely be attributed to the high rates of COVID-19 cases prevailing in the new year.?
Indeed, COVID-19 continued to be one of the top five telehealth diagnoses nationally and in all regions
but the Midwest.

One change that occurred in the top telehealth diagnoses in January 2021 was the disappearance of
exposure to communicable diseases (such as when a patient reports exposure to COVID-19) from the
rankings nationally and in every region. Other diagnoses varied by region, with substance use disorders
returning to the Northeast's list for the first time since September 2020, and developmental disorders and
diabetes mellitus joining the Midwest's list.

Also in January 2021, for the first time since the onset of the pandemic, a psychotherapy code became
the most common telehealth procedure code nationally. The procedure code, CPT 90837 (60-minute
psychotherapy), had been the second most common telehealth procedure code in December 2020 (and
for several months in late 2020), while CPT 99213 (15-minute established patient office or other
outpatient visit) had been in first place.1° The following month, the two codes switched places.

 

® Will Feuer and Nate Rattner, "U.S. Reports Record Number of Covid Deaths in January as New Strains Threaten
Progress," CNBC, January 27, 2021, hitps:/Awww.cnbc.com/2021/01/27/us-reports-record-number-of-covid-deaths-in-

january.html.
10 In 2021, CPT 99213 changed its description from a 15-minute established patient office or other outpatient visit to a

20 to 29-minute established patient outpatient visit.

Health The Evolution of Telehealth during the COVID-19 Pandemic 7

Know Your Source

 
In February 2021, telehealth experienced its first month-to-month drop in national utilization since
September 2020. Telehealth's share of medical claim lines fell 15.71 percent nationally, decreasing from
7 percent of medical claim lines in January 2021 to 5.9 percent in February 2021. Telehealth utilization
also declined in all four census regions, with the greatest drop in the West, where the decrease was
18.28 percent (figure 8). This change may have been related to the national drop in COVID-19 cases
reported to the CDC in February," which also resulted in the disappearance of COVID-19 from the top
five telehealth diagnoses lists nationally and in every region that month.

 

    

nee eV UMMM cli stl Mm accre [elites (e.Cc eae Pak =) 04
Pre oe West: ax, az,.ca, co. Hi, 10, ut nv, Nit on, UT, wa. wy | A Month-to-Month Comparison
Top Five Procedure Codes by Utilization CDvowume of Claim Lines
In order from most io feast comment
Jan. 2021 Feb, 2021
9.3%
se PATENT OUTPATIENT WSS, TOTALTINE 3048 a 76%
a1 rape PATIENT OUTPATIENT WSIT, TOTAL TIME 20-29.
say PSYOHOTHERAPY, aHMINUTES
ae PSYCHOTHERAPY: a4 MISLITES : a
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Bi mes dan: 2021 Feb. 2021
© Top Five Diagnoses (yr Mental Health Diagnoses, Feb. 2024
Jan. 2021 8 Feb. 2024 Fen 3004

an tines
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Generaized Ansiety Disorder | YT aa

45.4%

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i Oh 10% 20% we 4
nd Metabolic cdars Percent of mental heallh tslebeath darn lines

 

Source: FH NPIC* cwiehase of mone man P vb more ran BO contity (Copyright 2021. FAR Heath, ine Al nights sesened GPT 6 2070 Amencan Medical Assocation (AMA) Al nents resend

 

 

fairhealth.org | fairhealthconsumer.org | fairhealthconsumidor.org | 955-301-FAIR (3247) | info@fairhealth.org

Figure 8. Monthly Telehealth Regional Tracker: January versus February 2021, West

In COVID-19's stead, other conditions joined the rankings of the top five telehealth diagnoses in February
2021. Hypertension joined the national list, substance use disorders joined the list in the Midwest,
developmental disorders joined the list in the South, and diabetes mellitus and endocrine and metabolic
disorders joined the top five in the West (figure 8).

Mental health conditions continued to be the number one telehealth diagnosis nationally and regionally in
both January and February 2021. Within that category, nationally and in all regions but the West, the top
granular diagnosis was generalized anxiety disorder. In the West, the top mental health diagnosis was
major depressive disorder (figure 8). Other conditions included in the rankings were adjustment disorders,
attention-deficit hyperactivity disorder, bipolar disorder, mood affective disorders and post-traumatic
stress disorder.

 

11 "COVID Data Tracker," CDC, last updated May 25, 2022, httos://covid.cdc.gov/covid-data-
tracker/#irends_dailytrendscases.

Health The Evolution of Telehealth during the COVID-19 Pandemic 1

Know Your Source

 
Spring 2021

In spring 2021, telehealth utilization continued the national decrease that began in February. Telehealth
claim lines decreased from 5.9 percent of all medical claim lines in February to 5.6 percent in March and
4.9 percent in April (figure 9). This decline coincided with a national drop in COVID-19 cases and
increasing vaccination rates.12

Clay eUeretc tame (et: Dee lela Ce Ata |

 

 

Teer ceilhidle Lig Ma alll a Wale ate ans able

her era ees United States | A Month-to-Month Comparison

Qr Five Procedure Codes by Utilization @ Volume of Claim Lines
Jn order from mast io Jeast common
Mar, 2024 Apr. 2021

085 PSYCHOTHERAPY, SOMNUTES wer ev MINUTES =o
on eSTABLCHED PATIENT QUTPATEM! WT, TOTAL Tive 9.90 = ESYABLED PATIENT OUTPATET Hn, TOTAL TE 2828 3 os 5.6% bo%
ee : 5

Mar. 2021 Apr. 2021

 

rp Mental Health Diagnoses, Apr. 2021
Apr. 2021

Generalized Armiehy Disorder -_7 2.2%

Mar. 2021 2 Apr. 2024

  
 
 

  
 
 

a 9%

 

tas

Peroent of talenealth claim lines
a
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|
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|

  

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@ Acute Respiratory Diseases and Infecbons
@ General Sons and Symptoms:

'Sours FH APIO" dlabacess of more that 34 bea pried hibedl mariced and Geel cli records stow more thar 60) contrinuniers nationwiss Copyright 202%. FAI Heath. ine, Al igmts reserved CPT 200 American Médical Aasociates (AMA) Al Spf raseretd

 

UR Ee Ce Ee eM ec Lime |

Figure 9. Monthly Telehealth Regional Tracker: March versus April 2021, United States

The decline in telehealth utilization appeared to be driven by the return of non-mental-health services to
in-person settings from telehealth, where they had shifted during the COVID-19 pandemic. In March,
nationally and in several regions, psychotherapeutic/psychiatric codes replaced or outranked E&M
services in the list of top five telehealth procedure codes. For example, in the South, CPT 90837 (60-
minute psychotherapy) rose from the number three to the number one position in the top five list,
supplanting two E&M codes: CPT 99214 (30-39-minute established patient outpatient visit) and CPT
99213 (20-29-minute established patient outpatient visit). This trend of psychotherapeutic/psychiatric
codes rising and E&M codes falling as a percentage of telehealth procedure codes continued into April
and May.

Mental health conditions remained the number one telehealth diagnosis category nationally and in every
region, with their national percentage of telehealth claim lines rising from March to May 2021. Nationally,
for example, mental health conditions increased from 57 percent of telehealth claim lines in March to 58.6
percent in April (figure 9). Within the category of mental health conditions, there were no changes in the
rankings of top mental health diagnoses nationally or regionally. In addition, in May 2021, substance use
disorders were found among the lists of top diagnoses nationally, in the Midwest and Northeast, which
was consistent with reports of increased misuse of opioids and stimulants during the pandemic. '?

 

12 Liz Hamel, Grace Sparks and Mollyann Brodie, "KFF COVID-19 Vaccine Monitor: February 2021," KFF, February
26, 2021, httos:/Awww.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-february-2021/.

13 Ashley Abramson, "Substance Use during the Pandemic," American Psychological Association, March 1, 2021,
https:/Awww.apa.org/monitor/2021/03/substance-use-pandemic.

Health The Evolution of Telehealth during the COVID-19 Pandemic 16

Know Your Source

 
Other top telehealth diagnoses continued to evolve as COVID-19 vaccinations increased and adult
conditions were returning to in-office treatment. In March 2021, hypertension, as well as joint and soft
tissue diseases, dropped in the rankings of telehealth diagnoses nationally and in some regions.
Developmental disorders remained steady or rose in the rankings, however; this may be because children
were not yet eligible for vaccination in March 2021. In the following spring months, acute respiratory
diseases and infections climbed in the rankings of top telehealth diagnoses, becoming the third most
common diagnosis nationally and appearing among the lists in every region by May 2021. As the COVID-
19 pandemic seemingly waned, this suggested a return to non-COVID respiratory conditions, such as
colds and bronchitis.

Summer 2021

Telehealth utilization continued to decline at the beginning of summer 2021. Nationally, telenealth claim
lines as a percentage of all medical claim lines fell 10 percent from May to June 2021 and 6.67 percent
from June to July 2021. The percentage of medical claim lines attributable to telenealth also fell in all four
US census regions, with the sharpest decreases occurring in the Northeast in June and in the South in
July.

In August 2021, however, telehealth utilization as a percentage of all medical claim lines rose nationally
by 2.38 percent and in all US census regions (except the Midwest), halting months of decline. The growth
in the South surpassed that in all other geographical areas, rising 12.9 percent from July to August 2021
(figure 10). This growth coincided with the peak of the surge in COVID-19 cases driven by the Delta
variant in the South.'* This may suggest that the increase in telehealth use was propelled by patients and
providers seeking a venue of care that reduced the risk of disease transmission.

 

 

  
  

ional Tracker, July vs. Aug. 2021
a trVh i) eS
Pee ee Se Uae cma ae a Ped LUSH ee ene ela meri eo Ri
Qyro Five Procedure Codes by Utilization Qo ume of Claim Lines
In ordar fram mast fo least common
duly 2021 Aug, 202
ee a | 12.90%
"ooh? PSYCHOTHERAPY 60 NLTTES (ser £ Six
gon he ee ee eet ESTABUSHED PATIENT OUTPATIENT WISIT, TOTAL TIME 20-23 Z ast
ges PHYSHCIAN TELEPHONE PATIENT SERMICE S10 MINUTES OF UEDICAL ] eae PRY SICIAN TELEPHONE PATIENT SERVICE, S10 KIMUITES OF 5 1

July 2024 Aug. 2024

rw Mental Health Diagnoses, Aug, 2021

Aug. 2021

   

 

Altant on-Daficit Hyperaclivity

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fe
i

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roe Expolar Disender 5.5%

'ane i=]

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20% 30% 40%

ental Health alaheallh elim lines

 

 

Souror FH MPIC" database of morn than 3 prtvatety i fr than 70) corte : Copyright 2001, FAIR Haan, Inc. Al cgtts msarved. CPT ©2030 American Medical Acsociaton (ANA) A richls reserved |

 

 

fairhealth.org | fairhealthconsumer.org | fairhealthconsumidorerg | $55-301-FAIR (3247) | info@fairheatth.org

Figure 10. Monthly Telehealth Regional Tracker: July versus August 2021, South

There were some changes in the top five telehealth procedure codes by utilization that summer, though
CPT 90837 (60-minute psychotherapy) maintained its number one rank nationally and in all regions,

 

14 David Leonhardt and Ashley Wu, "Has Delta Peaked?," New York Times, September 1, 2021, updated September
17, 2021, https:/Awww.nytimes.com/2021/09/01/briefing/delta-peak-covid-caseload.html.

Health The Evolution of Telehealth during the COVID-19 Pandemic 17

Know Your Source

 
which it assumed in March 2021. Nationally, in June 2021, CPT 99214 (30-39-minute established patient
outpatient visit) rose from third to second place, while CPT 99213 (20-29-minute established patient
outpatient visit) fell from second to third place; however, these codes reversed their change in places in
July 2021. In August 2021, CPT 99441 (5-10 minute physician telephone patient service) joined the top
five telehealth procedure codes nationally. Ranking at number five, it displaced CPT 90833 (30-minute
psychotherapy performed with E&M visit).

The Telehealth Tracker reported changes in top diagnoses throughout the summer of 2021. In the South,
urinary tract infections and skin infections and issues ranked among the top diagnoses from June to
August 2021 (figure 10). This was the first time since the start of the pandemic in March 2020 that these
diagnoses appeared on the regional or national lists, although they had been common on the lists prior to
the pandemic. Acute respiratory diseases and infections continued to rise in the national ranking, making
up 2.9 percent of telehealth claim lines in June 2021 and 4.2 percent by August 2021.

COVID-19 joined the top five telehealth diagnoses nationally in August 2021, the first time it had done so
since January 2021. While COVID-19 ranked at number five among telehealth diagnoses nationally in
August, it ranked at number three in the South (figure 10). The only region where it did not appear in the
top five was the Northeast. The increase in claim lines associated with COVID-19 may have driven a
decrease in mental health conditions' share of telehealth claim lines, which declined in the South from
50.1 percent in July to 47.5 percent in August 2021 (figure 10). Despite this drop, mental health
conditions remained the number one telehealth diagnosis nationally and in every region.

Nationally, generalized anxiety disorder maintained its rank as the top mental health diagnosis via
telehealth throughout the summer of 2021, followed by major depressive disorder, adjustment disorders,
attention-deficit hyperactivity disorder and bipolar disorder. In August 2021, post-traumatic stress disorder
(PTSD) appeared in the number five rank in the Northeast, displacing bipolar disorder. It was the first time
in months that PTSD had ranked among the top five mental health diagnoses in any region but the
Midwest, where it has been number five since February 2021.

Health The Evolution of Telehealth during the COVID-19 Pandemic 18

Know Your Source

 
Fall 2021

With the decline of the Delta variant's presence and the emergence of the highly transmissible Omicron
variant, the use of telehealth and top telehealth diagnoses fluctuated throughout the fall of 2021. In
September, for the second straight month, national telehealth utilization grew 2.33 percent, accounting for
4.4 percent of all medical claim lines (figure 11). Though COVID-19 dropped out of the top five telehealth
diagnoses nationally, it remained on the list in the Midwest. In its place, substance use disorders joined
the top diagnoses nationally, and developmental disorders rose from fourth to third place in the ranking
(figure 11).

Monthly Telehealth Regional Tracker, Aug. vs. Sep. 2021

 

 

      

 

 

et :
eee ree United States | A Month-to-Month Comparison
Top Five Procedure Codes by Utilization (Dovotume of Claim Lines
In order trom mest io east common
Aug. 2024 Sep. 2021 Ce ecm a
re A 204
ae ESTABLISHE ATER VIST, TOTAL TIME 25:98 wae 'OUTPATIENT VISIT. TOTAL TIME 20.29 '4 43% 44%
2), nats oii : _ 3 4%
a eee ix Bee 7
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aia es . : &
ne PHYSICIAN TELEPHONE PATIENT SERVICE, §-10MINLUTES OF MEDICAL p ND 0%
cal cm Aug, 2021 Sep. 2021
@ Top Five Diagnoses © Mental Health Diagnoses, Sep. 2021
Sep. 2024 Sin. Hi
ota

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'Source: FH NPS Boil bided ehedicat i fore than 70. cont: ido. Copytk, FAIR Healt lnc. AD right: reserved. CPT 0.2000 Amercan Wadtal Association (AMAL A nett reserved,

 

Ce MILL ase MEM CL ia gc Re Ce Le TTS gy

Figure 11. Monthly Telehealth Regional Tracker: August versus September 2021: United States

In October 2021, telehealth experienced a sharp decline in national utilization, falling 6.82 percent in its
share of all medical claim lines. All regions except for the Northeast also saw a decline in telehealth
utilization that month. The greatest decline (11.43 percent) occurred in the South. As telehealth usage
fell, COVID-19 disappeared from top diagnoses in the Midwest and, as a result, was no longer in the top
five nationally or in any region. The Midwest joined the Northeast in having substance use disorders
among its top five telehealth diagnoses.

Health The Evolution of Telehealth during the COVID-19 Pandemic 1)

Know Your Source

 
In November 2021, when the Omicron variant was first detected in the United States, 15 telehealth's share
of medical claim lines increased 7.32 percent nationally as compared to the prior month; it also increased
in every region, with the greatest increase (8.33 percent) occurring in the Northeast (figure 12).
Substance use disorders fell out of the national list of top telehealth diagnoses to make way for the return
of COVID-19, which ranked in fifth place. In the Northeast, COVID-19 also returned to the top five
telehealth diagnoses (figure 12); it had not been listed in that region since January 2021. The Midwest
also saw the reappearance of COVID-19 on its list. Also in these two regions, joint/soft tissue diseases
and issues dropped out of the top five.

Health

 

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an

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Jn order fem most to leas! coamman
Oct. 2021
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= pe ere a rh bal es

 

of medica! dain lines

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Oct 2021 Now. 2021
© Top Five Diagnoses v0 Mental Health Diagnoses, Nov. 2021
mim, «Oct. 2024 # eaig -- Now. 2021 Nov. 2024
4% a Oh Major sorder 24.1%
:

  

. Ch . Adjustment Disorders. EE) 8.1%
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Ce i ue realm eer RPC OUST RolEs|

Figure 12. Monthly Telehealth Regional Tracker: October versus November 2021, Northeast

 

Mental health conditions remained the top-ranking telehealth diagnosis nationally and in every region.
Similarly, CPT 90837 (60-minute psychotherapy) maintained its position as the number one procedure
code nationally and in every region. Changes in the top telehealth procedures in the fall of 2021 included
the addition of CPT 90833 (30-minute psychotherapy performed with E&M visit) to the national list in
September. It maintained its rank as number five for the rest of the fall. Nationally and in the Midwest,
CPT 99213 (20-29-minute established patient outpatient visit) and CPT 99214 (30-39-minute established
patient outpatient visit) switched places in November 2021.

 

15 "First Confirmed Case of Omicron Variant Detected in the United States," CDC, December 1, 2021,
https:/Avwww.cdc.gov/media/releases/2021/s1201-omicron-variant.html.

Health The Evolution of Telehealth during the COVID-19 Pandemic 20

Know Your Source

 
In December 2021, telehealth's share of medical claim lines increased nationally by 11.36 percent, from
4.4 percent of all medical claim lines in November to 4.9 percent in December. Telehealth utilization also
increased in every US census region, with the greatest increase (18.18 percent) in the South (figure 13).

 

 
   

     
   

nee Monthly Telehealth Regional Tracker, Nov. vs. Dec. 2021 Gases
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Figure 13. Monthly Telehealth Regional Tracker: November versus December 2021, South

The December 2021 increases in telehealth utilization coincided with the nationwide surge of COVID-19
cases, 6 fueled by the Omicron variant. COVID-19, which was among the top five telehealth diagnoses
nationally and in the Midwest and Northeast, continued to hold that status in December, while also joining
the top five telehealth diagnoses in the South (figure 13) and West. Nationally, from November to
December 2021, COVID-19 rose from fifth place to third place among telehealth diagnoses; in the
Northeast, the epicenter of December's Omicron surge, COVID-19 rose from fifth place to second place.

Mental health conditions remained the number one diagnosis in the nation and all regions, but
everywhere fell in percentage share. In the South, mental health conditions fell to less than 50 percent of
telehealth claim lines (43.4 percent), the only region where that was the case (figure 13). Similarly, the
percentage share of CPT 90837 (60-minute psychotherapy) fell nationally and regionally among the top
procedure codes; in the South, it fell from first to third place (figure 13). This was part of a general trend in
December 2021 toward lower utilization of psychotherapeutic/psychiatric procedure codes and higher
utilization of E&M codes. For example, in the Midwest, CPT 99212, an E&M code (10-19-minute
established patient outpatient visit), supplanted CPT 90833, a psychotherapeutic code (30-minute
psychotherapy performed with E&M visit), in fifth place among telehealth procedure codes.

 

16 Lauren Leatherby, Charlie Smart and Amy Schoenfeld Walker, "Omicron Drives US Virus Cases past Delta's
Peak," New York Times, December 23, 2021, https:/Awww.nytimes.com/interactive/2021/12/23/us/omicron-case-
count.html.

Health The Evolution of Telehealth during the COVID-19 Pandemic my

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Monthly Telehealth Regional Tracker 3.0 (2022)

The Telehealth Tracker underwent further changes in its third year of reporting on telehealth's evolution.
Beginning in 2022, each infographic shows month-to-month changes in telehealth's volume of claim lines,
top five procedure codes, top five diagnoses and top five specialties. The Telehealth Tracker also now
features the Telehealth Cost Corner, which presents a specific telehealth procedure code with median
charge and allowed amounts.

Winter 2022

As the wave of cases related to the Omicron variant persisted into 2022, telehealth utilization further
increased, capturing 5.4 percent of all medical claim lines nationally in January 2022-a 10.2 percent
increase from the month before. The West, which experienced the greatest increase in telehealth
utilization (17.54 percent), was the only location where COVID-19 did not fall in its share of telehealth
claim lines. This diagnosis continued to rank at number two or three among the top five telehealth
diagnoses nationally and in all regions.

Mental health conditions remained in first place among the top diagnoses nationally and in all regions, but
certain other diagnoses changed. Developmental disorders, for example, rejoined the top five diagnoses
in the Northeast after a month off the list, and encounter for examination rejoined the top five in the South
after a month off that list.

In January 2022, social worker was the leading telehealth specialty nationally and in all regions but the
West, where primary care physician was the leading telehealth specialty, 0.1 percent ahead of social
worker. In every other region and nationally, primary care physician was in second place behind social
worker. Nationally, psychiatrist, psychologist and primary care nonphysician were in third, fourth and fifth
place, respectively.

Health The Evolution of Telehealth during the COVID-19 Pandemic 22

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In February 2022, following three months of growth, telehealth's share of medical claim lines declined
9.26 percent nationally, likely due to a sharp decline in new cases of COVID-19"" and diminishing
concerns about infection (figure 14). Accordingly, COVID-19 fell out of the top five telehealth diagnoses
nationally and in every US census region. Other diagnoses rose to take its place, such as substance use
disorders, which reentered the top five nationally (figure 14) and in the Midwest and moved from fourth
place to second place in the Northeast. Developmental disorders reentered the top five in the South, and
endocrine and metabolic disorders reentered the top five in the West.

Monthly Telehealth Regional Tracker, February 2022

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Figure 14. Monthly Telehealth Regional Tracker: February 2022, United States

Also in February 2022, social worker became the most common specialty used for telehealth in the West,
a position it continued to hold in every other region and nationally. Given that the most common telehealth
service social workers provide is psychotherapy, it is unsurprising that CPT 90837 (60-minute
psychotherapy), the leading procedure code nationally and regionally, rose everywhere in its percentage
share of claim lines.

In January and February, the Telehealth Cost Corner spotlighted the costs of CPT 92507, treatment of
speech, language voice, communication and/or hearing processing disorder, and CPT 90791, psychiatric
diagnostic evaluation, respectively. Nationally, the median charge amount for CPT 92507 when rendered
via telehealth was $129.92, and the median allowed amount was $77.64. The national median charge
amount for CPT 90791 when rendered via telehealth was $202.94, and the median allowed amount was
$120.89 (figure 14).

Spring 2022

In March 2022, telehealth utilization, as measured by telehealth's share of all medical claim lines,
continued to fall, decreasing 6.1 percent nationally from the previous month. Telehealth utilization also
decreased in March in every US census region (Midwest, Northeast, South and West), with the greatest
decrease (8.1 percent) in the South, followed closely by the West (7.8 percent). The drop in telehealth

 

17 Tina Reed, "COVID Cases Continue Steep Decline in U.S.," Axios, March 3, 2022,
https:/Avww.axios.com/2022/03/03/covid-cases-continue-steep-decline-in-us.

Health The Evolution of Telehealth during the COVID-19 Pandemic 23

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utilization was likely due to continuing reduction in the reported number and severity of COVID-19
infections,'® which may have led more patients to return to in-person healthcare services.

The top telehealth procedure codes did not change nationally or in any region, with CPT 90837 (60-
minute psychotherapy) maintaining its number one rank. The top diagnoses nationally likewise remained
the same in March, but there were some changes at the regional level. In the Northeast, acute respiratory
diseases and infections rose from fifth place to second place in the rankings. In the South, encounter for
examination fell off the list and urinary tract infections rejoined the list (in fifth place) for the first time since
December 2021.

Similarly, the rankings of the top five telehealth specialties saw only one change in March 2022. In the
Midwest, psychiatrist and primary care nonphysician switched places, with the former rising to fourth
place in March and the latter dropping to fifth place. In all regions and nationally, for the second month in
a row, social worker remained the top telehealth specialty.

For March 2022, the Telehealth Cost Corner shed light on the cost of CPT 97803, therapy procedure
reassessment for nutrition management, each 15 minutes. Nationally, the median charge amount for this
service when rendered via telehealth was $49.97, and the median allowed amount was $31.58.

Conclusion

Although telehealth was somewhat increasing before the COVID-19 pandemic, the onset of the pandemic
led to growth on a scale not previously seen. From March 2020 to February 2022, changes in telehealth
utilization were seemingly driven by the course of the pandemic. Given that telehealth helped serve to
reduce the risk of COVID-19 transmission associated with in-person services, telehealth utilization
increases coincided with surges in COVID-19 cases. After the initial wave of the pandemic in spring 2020,
for example, telehealth claim lines, as a share of all medical claim lines, fell 33 percent nationally in May
2020. A few months later, during the fall 2020 wave of COVID-19, telehealth's share of medical claim
lines rose 10.6 percent nationally from September to October 2020. These monthly variations continued
through the start of 2022, though telehealth utilization never declined to pre-pandemic rates; nationally,
telehealth accounted for only 0.17 percent of medical claim lines in January 2019, but 5.4 percent of claim
lines in January 2022.

Another key finding is the distinction between top procedures and diagnoses conducted via telehealth
before and during the pandemic. Pre-pandemic, the services most commonly performed via telehealth
were telephone visits, shorter E&M services and patient self-management education. By the end of 2020,
the top five procedure codes had largely stabilized, consisting of psychotherapeutic/psychiatric services
and longer E&M visits.

Similarly, the pandemic ushered in the use of telehealth to treat a wider variety of conditions. Rather than
diagnosing influenza and pneumonia and skin infections and issues, telehealth was-and still is-being
used to treat conditions such as developmental disorders, joint/soft tissue diseases and issues, and
hypertension. Diagnoses treated via telehealth varied by region; for example, substance use disorders
first appeared on the list of top diagnoses in the Northeast in July 2020, but did not emerge on another
region's list until February 2021. Diabetes mellitus made appearances among the top five telehealth
diagnoses in the Midwest and West but not in the Northeast and South.

One of the Telehealth Tracker's most notable findings is the steady dominance of mental health
conditions as the most common telehealth diagnosis category throughout the pandemic. COVID-19 has
had a profound impact on mental health,'? and access to telehealth services has helped to meet the

 

18 "COVID Data Tracker," CDC.

19 Nirmita Panchal et al., The Implications of COVID-19 for Mental Health and Substance Use, KFF, February 10,
2021, https:/Avww.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-
substance-use/.

Health The Evolution of Telehealth during the COVID-19 Pandemic 24

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persistent demand for mental health services. This is demonstrated by month-over-month increases in
mental health conditions' share of telehealth claim lines, as well as the emergence of CPT 90837 (60-
minute psychotherapy) as the top telehealth procedure code nationally and in all regions from March
2021 through November 2021.

These findings reflect the changing nature of telehealth and how it has become a material component of
the nation's healthcare system. FAIR Health hopes the Monthly Telehealth Regional Tracker will continue
to serve as a resource for policy makers, researchers, payors, providers and others seeking to
understand and keep pace with the nation's evolving healthcare landscape. As the COVID-19 pandemic
unfolds, FAIR Health will continue to fulfill its healthcare transparency mission by using its reliable,
unbiased data to provide a window into telehealth's role in the healthcare system.

Health The Evolution of Telehealth during the COVID-19 Pandemic 25

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About FAIR Health

FAIR Health is a national, independent nonprofit organization dedicated to bringing transparency to
healthcare costs and health insurance information through data products, consumer resources and health
systems research support. FAIR Health qualifies as a public charity under section 501(c)(3) of the federal
tax code. FAIR Health possesses the nation's largest collection of private healthcare claims data, which
includes over 36 billion claim records and is growing at a rate of over 2 billion claim records a year. FAIR
Health licenses its privately billed data and data products-including benchmark modules, data
visualizations, custom analytics and market indices-to commercial insurers and self-insurers, employers,
providers, hospitals and healthcare systems, government agencies, researchers and others. Certified by
the Centers for Medicare & Medicaid Services (CMS) as a national Qualified Entity, FAIR Health also
receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and
D; FAIR Health includes among the private claims data in its database, data on Medicare Advantage
enrollees. FAIR Health can produce insightful analytic reports and data products based on combined
Medicare and commercial claims data for government, providers, payors and other authorized users.
FAIR Health's free, award-winning, national consumer websites are fairhealthconsumer.org and
fairhealthconsumidor.org. For more information on FAIR Health, visit fairhealth.org.

FAIR Health, Inc.

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