The utilization of telehealth experienced an unprecedented surge amid the COVID-19 pandemic, supported by policymakers’ proactive measures to facilitate its adoption through the relaxation of regulations and constraints. On May 11, 2023, the Public Health Emergency came to a close, ending various waivers pertaining to Medicare coverage and remuneration protocols for telehealth, while extending certain flexibilities. It is imperative for healthcare entities and medical billing outsourcing companies to remain informed of these revisions to maintain compliance and ensure reimbursement.
In times of social distancing, telehealth emerged as the pivotal tool, facilitating secure patient-physician interactions and seamless healthcare delivery. CMS expanded Medicare’s telehealth benefits during the PHE under the 1135 waiver authority. With the end of the PHE in May, CMS announced continuing and ending coverages that will impact the payment policies of services and supplies under its purview.
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Telehealth Policy Changes after the COVID-19 PHE
Several modifications were made regarding telehealth during the COVID-19 emergency, with some changes becoming permanent and others temporary. Here is an overview of the key changes that apply to physicians and nonphysician practitioners:
- Coverage for Medicare patients’ office and other outpatient visits (99202-99215) will continue until the end of 2024. Nevertheless, the new rule mandates both an auditory and visual engagement with the patient, and the visit must be medical necessary, duly supported by comprehensive documentation.
- Incident-to services will no longer be allowed via virtual supervision beginning Jan. 1, 2024. (“Incident-to services” refer to medical services provided by non-physician healthcare professionals, such as nurse practitioners, physician assistants, or other qualified healthcare personnel, under the supervision and direction of a physician. These services are billed and reimbursed as if the physician personally performed them).
- CMS has retained initial hospital and observation services (99221-99233) on its Telehealth Code List until no longer needed.
- All telehealth platforms must again be HIPAA compliant per Office of Civil Rights guidelines starting Aug. 9, 2023, which is 90 days after the end of the PHE. The use of smart phone video options, such as FaceTime and Skype, will be noncompliant after Aug. 9, 2023.
- As per Office for Civil Rights directives, all telehealth platforms are required to be HIPAA compliant again, effective from August 9, 2023, the date marking the conclusion of a 90-day period subsequent to the end of the PHE. Post August 9, 2023, the utilization of smartphone video solutions like FaceTime and Skype will no longer align with compliance standards.
- Medicare will continue to allow physicians and other qualified healthcare professionals to report audio-only telephone services with codes 99441-99443 for, but the CPT rules for using these services will apply. This implies that you can use these codes for established patients only.
- Medicare’s covered telehealth services includes services that can be provided via audio-only technology. Medicare proposes to revisit the list in its 2024 physician fee schedule. Although private insurers frequently take cues from the practices established by Medicare, some may decide to alter their PHE-era telehealth coverage policies earlier.
- Certain telehealth visits can be delivered audio-only (such as a telephone) if someone is unable to use both audio and video, such as a smartphone or computer. While reporting phone call services, providers should take care to avoid abuse or over-utilization. The patient’s medical record should explain why they couldn’t do a video telehealth call and had an audio-only call instead.
- CMS has waived the geographic and originating site requirements for Medicare telehealth services through the end of CY 2024. By doing so, patients all across the country will retain the ability to access telehealth services, especially from their own homes.
- Place of service (POS) codes will continue to depend on where the patient would have been had they been seen in person. However, POS 02 Patient not in their home when telehealth services are rendered, or POS 10 Patient in their home when telehealth services are rendered, can be reported, resulting in facility reimbursement.
- All telemedicine flexibilities regarding prescribing controlled substances have been extended through Nov. 11, 2023 by the Drug Enforcement Administration and Substance Abuse and Mental Health Services Administration. Clinician-patient telemedicine relationships established before Nov. 11, 2023, will have until Nov. 11, 2024 to continue using telemedicine flexibilities for controlled medications that were in place during the PHE.
- Modifier 95 can be reported for audio and video services for Medicare telehealth services through 2024.
- Modifier 93, Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system, became effective Jan. 1, 2022. Though modifier 93 was listed on the CMS news alert as a valid modifier to use on audio-only telehealth services, CMS has not stated that this is mandatory during the extension period of flexibilities. Providers should check with their payers on their individual contract rules on this modifier.
- Permanent Medicare changes:
- Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as a distant site provider for behavioral/mental telehealth services
- Medicare patients can receive telehealth services for behavioral/mental health care in their home
- There are no geographic restrictions for originating site for behavioral/mental telehealth services
- Behavioral/mental telehealth services can be delivered using audio-only communication platforms
- Rural Emergency Hospitals (REHs) are eligible originating sites for telehealth
- Some CMS proposals for 2024:
- Continue paying for telehealth services provided to patients in their homes at the non-facility payment rate, which is the same rate as inperson office visits
- Payment parity for telephone E/M services (CPT codes 99441-99443) and office visit established patient E/M codes of comparable length.
- Lift the frequency limits on telehealth visits for subsequent hospital and skilled nursing facility visits; and
- Allow direct supervision to be provided virtually.
As providers focus on ensuring that patients get the best care, they can rely on an experienced medical billing company to submit accurate claims and get paid faster. Outsourcing medical billing and coding to an expert can help clinicians code and bill telehealth services correctly in accordance with Medicare requirements.
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