{"id":40872,"date":"2022-11-30T15:10:13","date_gmt":"2022-11-30T20:10:13","guid":{"rendered":"https:\/\/mtelehealth.com\/?p=40872"},"modified":"2022-11-30T15:10:13","modified_gmt":"2022-11-30T20:10:13","slug":"cms-finalizes-changes-for-telehealth-services-for-2023","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/cms-finalizes-changes-for-telehealth-services-for-2023\/","title":{"rendered":"CMS Finalizes Changes for Telehealth Services for 2023"},"content":{"rendered":"\n\n\n

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released its final 2023 Medicare Physician Fee Schedule<\/a> (PFS) rule. As finalized, some of the most significant telehealth policy changes include:<\/p>\n\n\n\n

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  1. Discontinuing reimbursement of telephone (audio-only) evaluation and management (E\/M) services;<\/li>\n\n\n\n
  2. Discontinuing the use of virtual direct supervision;<\/li>\n\n\n\n
  3. Five new permanent telehealth codes for prolonged E\/M services and chronic pain management;<\/li>\n\n\n\n
  4. Postponing the effective date of the telemental health six-month rule until 151 days after the public health emergency (PHE) ends;<\/li>\n\n\n\n
  5. Extending coverage of the temporary telehealth codes until 151 days after the PHE ends;<\/li>\n\n\n\n
  6. Adding 54 codes to the Category 3 telehealth list and modifying their expiration to the later of the end of 2023 or 151 days after the PHE ends.<\/li>\n<\/ol>\n\n\n\n

    According to the September 2021 Medicare Telemedicine Snapshot<\/a>, telehealth services have increased more than 30-fold since the start of the PHE and have been utilized by more than half of the Medicare population. Telehealth and other digital health modalities continue to increase in importance for Medicare populations and corresponding health care providers. Consequently, as the PHE continues to wind down and the telehealth waivers near their end, CMS continues to grapple with how to maintain appropriate access to telehealth services without hitting the \u201cTelehealth Cliff.\u201d Much of the changes in the PFS reflect this struggle and the challenge of post-PHE re-imposition of the Social Security Act\u2019s Section 1834(m) requirements for telehealth. <\/p>\n\n\n\n

    Discontinuing Reimbursement of Telephone (Audio-Only) E\/M Services<\/h2>\n\n\n\n

    Under PHE waivers, CMS allowed separate reimbursement of telephone (audio-only) E\/M services (CPT codes 99441-99443), something embraced by many practitioners and patients, particularly patients in rural areas or without suitable broadband access, as well as patients with disparities in access to technology and in digital literacy. <\/p>\n\n\n\n

    Yet, audio-only was not universally embraced as a permanent covered service with separate reimbursement. In the final rule, CMS elected to discontinue such coverage post-PHE, and did not permanently add these services to the Medicare Telehealth Services List. With the exception of certain telemental health services, CMS stated two-way interactive audio-video telecommunications technology will continue to be the Medicare requirement for telehealth services following the PHE. This is because Section 1834(m)(2)(A) of the Social Security Act requires telehealth services be analogous to in-person care by being capable of serving as a substitute for the face-to-face encounter. CMS stated, \u201cwe believe that the statute requires that telehealth services be so analogous to in-person care such that the telehealth service is essentially a substitute for a face-to-face encounter.\u201d As audio-only telephone is inherently non-face-to-face, CMS determined the modality fails to meet the statutory standard. <\/p>\n\n\n\n

    CMS also rejected a request from a commenter to create a third virtual check-in code with a crosswalk to CPT code 99443 for a longer virtual check-in than the existing G2012 (5-10 minutes) and G2252 (11-20 minutes) codes. CMS\u2019 reasoning was that the virtual check-in codes are meant to be used to determine the need for care and as such, there is not a clear necessity for a longer virtual check-in code. <\/p>\n\n\n\n

    Therefore, 151 days after the PHE expires, with the exception of certain mental health telehealth services, audio-only telephone E\/M services will revert to their pre-PHE \u201cbundled\u201d status under Medicare (i.e., covered but not separately payable, also known as \u201cprovider-liable\u201d). Practitioners will no longer receive separate reimbursement for these services.<\/p>\n\n\n\n

    Discontinuing the Use of Virtual Direct Supervision<\/h2>\n\n\n\n

    Under Medicare Part B, certain types of services (e.g., diagnostic tests, services incident to physicians\u2019 or practitioners\u2019 professional services) must be furnished under the direct supervision of a physician or practitioner. For Medicare purposes, direct supervision requires the supervising professional to be physically present in the same office suite as the supervisee, and immediately available to furnish assistance and direction throughout the performance of the procedure. The supervising professional need not be present in the same room during the service, but the \u201cimmediate availability\u201d requirement means in-person, physical – not virtual – availability.<\/p>\n\n\n\n

    Among the PHE waivers, CMS temporarily changed<\/a> the direct supervision rules to allow the supervising professional to be remote and use real-time, interactive audio-video technology. That change did not require the professional\u2019s real-time presence at, or live observation of, the service via interactive audio-video technology throughout the performance of the procedure. This change was temporary because CMS was concerned widespread direct supervision through virtual presence may not be safe for some clinical situations.<\/p>\n\n\n\n

    In the final rule, CMS rejected requests to make virtual direct supervision a permanent feature in Medicare. Therefore, virtual direct supervision will expire at the end of the calendar year in which the PHE ends. With the extension of the PHE through January 11, 2023, virtual direct supervision will be available through at least the end of 2023.<\/p>\n\n\n\n

    Three New Telehealth Codes for Prolonged E\/M Services and Chronic Pain Management<\/h2>\n\n\n\n

    CMS rejected all stakeholder requests to permanently add codes to the Medicare Telehealth Services List. Following its standard evaluation process for such requests, CMS considered whether they met appropriate categories. <\/p>\n\n\n\n

    Category 1<\/a> services must be \u201csimilar to professional consultations, office visits, and\/or office psychiatry services that are currently on the Medicare Telehealth Services List.\u201d Category 2 services require \u201cevidence of clinical benefit if provided as telehealth\u201d and all necessary elements of the service must be able to be performed remotely. CMS rejected this year\u2019s requests because none of the proposed services (e.g., therapy, electronic analysis of implanted neurostimulator pulse generator\/transmitter, adaptive behavior treatment and behavior identification assessment codes) met the requirements of Category 1 or 2 services. Interested stakeholders should collect and submit better evidence to persuade CMS to add these codes on a Category 1 or 2 basis next year (submissions are due by February 10, 2023).<\/p>\n\n\n\n

    CMS itself proposed five new codes to be added to the Medicare Telehealth Services list on a permanent basis:<\/p>\n\n\n\n