FAIR Health Launches Telehealth Benchmarks

September 17, 2020

This September, FAIR Health is launching FH^® Telehealth, a new addition to our suite of FH^® Benchmarks. The new module includes charge benchmarks for services conducted via telehealth, a venue of care that has been rapidly expanding due to the COVID-19 pandemic.

Telehealth has demonstrated some growth over recent years, but the COVID-19 pandemic greatly increased its use because it enabled providers to treat patients while minimizing the risk of spreading the disease. A valuable complement to FAIR Health’s suite of benchmark products, FH Telehealth provides a means for understanding in greater depth the distinct pricing associated with medical services provided via video, telephone or other electronic means. Users can compare charges for services performed by providers through telehealth, as reflected in FH Telehealth, to charges for the same professional services provided in other venues of care, as reflected in other offerings through FH Benchmarks. In addition, FH Telehealth includes benchmarks for codes that are used exclusively for services provided via telehealth.

The information in FH Telehealth is vital for many stakeholders, including organizations considering expanding in the field of telehealth and negotiating contracts with providers and payors, insurance carriers evaluating pricing and plan design, and providers interested in pricing the services they offer via telehealth. Policy makers may find FH Telehealth helpful in evaluating the impact of telehealth reimbursement laws and regulations on telehealth utilization and reimbursement levels.

FH Telehealth includes values for all 493 geozips—geographic areas throughout the country that tend to track with the first three digits of a zip code—for almost 400 eligible procedure codes. When the volume of data is insufficient to create a benchmark based on actual reported charges, benchmarks are derived using a relative value and conversion factor methodology. The claims used to create the module contain telehealth-specific codes (e.g., CPT^®1 99441: physician telephone patient service, 5-10 minutes of medical discussion) and data with modifiers or place of service codes indicating that the procedure was provided via telehealth.

The data are based on a recent 12-month window of claims, and will be refreshed twice a year in September and March. Benchmarks are included for the mean, mode and 50th to 95th percentiles of billed charges.

FAIR Health President Robin Gelburd stated: “Given the growing prominence of telehealth as a venue of care, there is great interest in the costs associated with telehealth. We are pleased to address that interest with FH Telehealth, a new addition to our suite of benchmarks.”

For more information on FH Telehealth, contact FAIR Health by email at info@fairhealth.org or call 855-301-3247, Monday through Friday, 9 am to 6 pm ET.

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