SEC. 2. REQUIREMENT FOR PROVISION OF HIGH-COST DU-
RABLE MEDICAL EQUIPMENT AND LABORA-
TORY TESTS. 
(a) HIGH-COST DURABLE MEDICAL EQUIPMENT.— 
Section 1834(a)(1)(E) of the Social Security Act (42 
U.S.C. 1395m(a)(1)(E)) is amended by adding at the end 
the following new clause: 
‘‘(vi) STANDARDS FOR HIGH-COST DU-
RABLE MEDICAL EQUIPMENT.— 
‘‘(I) LIMITATION
ON
PAYMENT 
FOR
HIGH-COST
DURABLE
MEDICAL 
EQUIPMENT.—Payment may not be 
made under this subsection for a 
high-cost durable medical equipment 
ordered by a physician or other practi-
tioner described in clause (ii) via tele-
health for an individual on or after 
the date that is 180 days after the 
date of the enactment of this clause, 
unless such physician or practitioner 
furnished to such individual a service 
in-person at least once during the 6 
month period prior to ordering such 
high-cost durable medical equipment. 
‘‘(II) HIGH-COST DURABLE MED-
ICAL EQUIPMENT DETERMINATION.— 
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For purposes of this clause, the Ad-
ministrator of the Centers for Medi-
care & Medicaid Services shall define 
the term ‘high-cost durable medical 
equipment’ and specify the durable 
medical equipment for which such def-
inition shall apply. 
‘‘(vii) AUDIT
OF
PROVIDERS
AND 
PRACTITIONERS FURNISHING A HIGH VOL-
UME
OF
DURABLE
MEDICAL
EQUIPMENT 
VIA TELEHEALTH.— 
‘‘(I) IDENTIFICATION
OF
PRO-
VIDERS.—Beginning 6 months after 
the date of the enactment of this 
clause, Medicare administrative con-
tractors shall conduct reviews on a 
schedule determined by the Secretary, 
of claims for durable medical equip-
ment prescribed by a physician or 
other practitioner described in clause 
(ii) during the 12 month period pre-
ceding such review to identify physi-
cians or other practitioners with re-
spect to whom at least 90 percent of 
all durable medical equipment pre-
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scribed by such physician or practi-
tioner during such period was pre-
scribed pursuant to a telehealth visit. 
‘‘(II) AUDIT.—In the case of a 
physician or practitioner identified 
under subclause (I), with respect to a 
period described in such subclause, 
the Medicare administrative contrac-
tors shall conduct audits of all claims 
for durable medical equipment pre-
scribed by such physicians or practi-
tioners to determine whether such 
claims comply with the requirements 
for coverage under this title.’’. 
(b) 
HIGH-COST
LABORATORY
TESTS.—Section 
1834A(b) of the Social Security Act (42 U.S.C. 1395m– 
1(b)) is amended by adding at the end the following new 
paragraph: 
‘‘(6) REQUIREMENT FOR HIGH-COST LABORA-
TORY TESTS.— 
‘‘(A) LIMITATION ON PAYMENT FOR HIGH- 
COST LABORATORY TESTS.—Payment may not 
be made under this subsection for a high-cost 
laboratory test ordered by a physician or practi-
tioner via telehealth for an individual on or 
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after the date that is 180 days after the date 
of the enactment of this paragraph, unless such 
physician or practitioner furnished to such indi-
vidual a service in-person at least once during 
the 6 month period prior to ordering such high- 
cost laboratory test. 
‘‘(B) HIGH-COST LABORATORY TEST DE-
FINED.—For purposes of this paragraph, the 
Administrator for the Centers for Medicare & 
Medicaid Services shall define the term ‘high- 
cost laboratory test’ and specify which labora-
tory tests such definition shall apply to. 
‘‘(7) AUDIT
OF
LABORATORY
TESTING
OR-
DERED PURSUANT TO TELEHEALTH VISIT.— 
‘‘(A) IDENTIFICATION
OF
PROVIDERS.— 
Beginning 6 months after the date of the enact-
ment of this paragraph, Medicare administra-
tive contractors shall conduct periodic reviews 
on a schedule determined by the Secretary, of 
claims for laboratory tests prescribed by a phy-
sician or practitioner during the 12 month pe-
riod preceding such review to identify physi-
cians or other practitioners with respect to 
whom at least 90 percent of all laboratory tests 
prescribed by such physician or practitioner 
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during such period was prescribed pursuant to 
a telehealth visit. 
‘‘(B) AUDIT.—In the case of a physician 
or practitioner identified under subparagraph 
(A), with respect to a period described in such 
subparagraph, the Medicare administrative con-
tractors shall conduct audits of all claims for 
laboratory tests prescribed by such physicians 
or practitioners during such period beginning to 
determine whether such claims comply with the 
requirements for coverage under this title.’’. 
SEC. 3. REQUIREMENT TO SUBMIT NPI NUMBER FOR SEPA-
RATELY BILLABLE TELEHEALTH SERVICES. 
Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended by adding at the end the 
following new paragraph: 
‘‘(10) REQUIREMENT TO SUBMIT NPI NUMBER 
FOR
SEPARATELY
BILLABLE
TELEHEALTH
SERV-
ICES.—Payment may not be made under this sub-
section for separately billable telehealth services fur-
nished on or after the date that is 180 days after 
the date of the enactment of this paragraph by a 
physician or practitioner unless such physician or 
practitioner submits a claim for payment under the 
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national provider identification number assigned to 
such physician or practitioner.’’. 
Æ 
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