Telehealth after PHE ends

Telehealth Services After the PHE

After learning that the public health emergency (PHE) for COVID-19 was to end May 11, the healthcare industry wondered what telehealth services would remain covered. What regulations under the Consolidated Appropriations Act, 2023 (CAA) would extend coverage? Which provisions in the Medicare Physician Fee Schedule Final Rule be enforced? And which of the Centers for Medicare & Medicaid Services’ (CMS) many FAQ sheets would still be applicable?

Here is the most current information (as of May 21, 2023) that our providers and office staff need to know:
Office and other outpatient visits (99202-99215) will continue to be covered for Medicare patients through the end of 2024. However, an audio AND video connection with the patient is required and the visit must be medically necessary (with documentation supporting the claim).

Incident-to services will no longer be allowed via virtual supervision beginning Jan. 1, 2024.

Initial hospital and observation services (99221-99233) will remain on CMS 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.

Medicare will continue to allow audio-only telephone services to be reported with codes 99441-99443 for physicians and other qualified healthcare professionals, but the CPT® rules for using these services will apply. This means that you can use these codes for established patients only. Payment parity to evaluation and management (E/M) codes 99212-99214 (when modifier 95 is used) will end Dec. 31, 2024.

“Certain” behavioral and mental health services will now be permanently offered under telehealth for Medicare patients. Please review CMS’ List of Telehealth Services to know what falls under this policy. E/M services are not part of this policy.

Place of service (POS) codes will continue to be based 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, may be reported. Reporting these specific POS codes will result in facility reimbursement.

You should continue to use Modifier 95 for audio and video services for Medicare telehealth services through 2024.
Modifier 93 was listed on the CMS news alert as a valid modifier to use on audio-only telehealth services, but CMS has not said this is mandatory during the extension period of flexibilities. Commercial plans will have individual contract rules on this modifier.

It’s important to note that ongoing OIG audits for fraud, waste, and abuse will continue, and CMS and other payers will make sure that phone call services are not abused or over-utilized. If you did not report these types of service prior to the PHE, then it may not be appropriate to report them now.

  • Documentation Requirements for Telehealth Services
    The Consolidated Appropriations Act, 2023, extended many telehealth flexibilities through December 31, 2024, such as:
    People with Medicare can access telehealth services in any geographic area in the United States, rather than only those in rural areas.
    People with Medicare can stay in their homes for telehealth visits that Medicare pays for rather than traveling to a health care facility.

This last bullet is important because the patient’s medical record will need to reflect why the patient was not able to get on an audio and video telehealth call and instead settled for an audio-only call. I would be willing to bet that “convenience” excuses will not fly with the federal government as a reason for an audio-only telemedicine encounter even while we are under the 1135 waiver extension.

At this point, providers should not be allowing the convenience of the phone call over the medical appropriateness of the in-person and/or audio and video encounter. There should be a telehealth facilitator in your practices — any front desk, back office or billing office employee can take this on to ensure appropriate internet connections for patients are conducted on a HIPAA-approved device and/or platform. Yes, there is a time for audio-only, but those should be rare — not for new patients and not for routine information to patients.

Providers Should Think Twice Before Working from Home
Latest CMS update (2/24/2023), requiring that providers who continue to be in their own home when treating patients via telehealth will have to go back to the rules under the Medicare provider enrolment regulations (PECOS) by the end of 2023. They will have to list their home as a separate location. This means that their physical home address will be on every public website, showing patients and any person out there, where the physician lives. This is a safety concern not only for the physician but also for their families.