On July 7, 2022, the Facilities for Medicare and Medicaid Companies (CMS) launched its proposed 2023 Medicare Doctor Payment Schedule (PFS) rule. The rule, if enacted as proposed, will:
- Create three new everlasting telehealth codes for extended E/M companies;
- Discontinue reimbursement of phone (audio-only) E/M companies;
- Discontinue using digital direct supervision;
- Postpone the efficient date of the telemental well being six-month rule till 151 days after the PHE ends;
- Lengthen protection of the short-term telehealth codes till 151 days after the PHE ends; and
- Add 54 codes to the Class 3 telehealth checklist.
Studying between the strains, the character of CMS’ feedback and the modifications it proposed (and refused to suggest) counsel that CMS rulemakers anticipate the Public Well being Emergency (PHE), and related PHE waivers, will expire no later than the primary half of 2023.
Three New Telehealth Codes for Extended E/M Companies
This 12 months, CMS rejected all stakeholder requests to completely add codes to the Medicare Telehealth Companies Checklist. Following its customary analysis course of for such requests, CMS thought of whether or not they met acceptable classes. Class 1 companies have to be “much like skilled consultations, workplace visits, and/or workplace psychiatry companies which can be at the moment on the Medicare Telehealth Companies Checklist.” Class 2 companies require “proof of medical profit if offered as telehealth” and all crucial parts of the service should be capable of be carried out remotely. CMS rejected this 12 months’s requests as a result of not one of the proposed companies (e.g., remedy, digital evaluation of implanted neurostimulator pulse generator/transmitter, adaptive habits therapy and habits identification evaluation codes) met the necessities of Class 1 or 2 companies. stakeholders can gather and submit higher proof to steer CMS so as to add these codes on a Class 1 or 2 foundation subsequent 12 months (submissions are due by February 10, 2023).
Though it rejected stakeholder-submitted codes, CMS itself proposed three new codes to be added to the Medicare Telehealth Companies checklist on a everlasting foundation:
- GXXX1 (Extended hospital inpatient or commentary care analysis and administration service(s) past the entire time for the first service (when the first service has been chosen utilizing time on the date of the first service); every further quarter-hour by the doctor or certified healthcare skilled, with or with out direct affected person contact (checklist individually along with CPT codes 99223, 99233, and 99236 for hospital inpatient or commentary care analysis and administration companies).
- GXXX2 (Extended nursing facility analysis and administration service(s) past the entire time for the first service (when the first service has been chosen utilizing time on the date of the first service); every further quarter-hour by the doctor or certified healthcare skilled, with or with out direct affected person contact (checklist individually along with CPT codes 99306, 99310 for nursing facility analysis and administration companies).
- GXXX3 (Extended dwelling or residence analysis and administration service(s) past the entire time for the first service (when the first service has been chosen utilizing time on the date of the first service); every further quarter-hour by the doctor or certified healthcare skilled, with or with out direct affected person contact (checklist individually along with CPT codes 99345, 99350 for dwelling or residence analysis and administration companies).
CMS added these codes as a result of they’re much like present CPT codes 99356 and CPT 99357 and HCPCS code G2212, all listed on a everlasting foundation.
Discontinue Reimbursement of Phone (Audio-Solely) E/M Companies
Below PHE waivers, CMS allowed separate reimbursement of phone (audio-only) E/M companies (CPT codes 99441-99443), one thing that was embraced by a sizeable cohort of practitioners and sufferers, notably in rural areas or sufferers with out appropriate broadband entry for audio-video.
CMS rejected requests to completely add these companies to the Medicare Telehealth Companies Checklist. Apart from sure telemental well being companies, CMS acknowledged two-way interactive audio-video telecommunications expertise will proceed to be the Medicare requirement for telehealth companies following the PHE. It is because Part 1834(m)(2)(A) of the Social Safety Act requires telehealth companies be analogous to in-person care by being able to serving as an alternative choice to the face-to-face encounter. In CMS’ personal language, “We imagine that the statute requires that telehealth companies be so analogous to in-person care such that the telehealth service is basically an alternative choice to a face-to-face encounter.” As audio-only phone is inherently non-face-to-face, CMS decided, that modality fails to satisfy the statutory customary.
Due to this fact, 151 days after the PHE expires, audio-only phone E/M companies will revert to their pre-PHE “bundled” standing below Medicare (i.e., coated however not individually payable). Practitioners will not obtain separate reimbursement for these companies.
Discontinue the Use of Digital Direct Supervision
Below Medicare Half B, sure forms of companies (e.g., many diagnostic assessments, companies incident to physicians’ or practitioners’ skilled companies) have to be furnished below the direct supervision of a doctor or practitioner. For Medicare functions, direct supervision requires the supervising skilled to be bodily current in the identical workplace suite because the supervisee, and instantly out there to furnish help and route all through the efficiency of the process. The supervising skilled needn’t be current in the identical room throughout the service, however the “fast availability” requirement means in-person, bodily – not digital – availability.
In reference to PHE waivers, CMS quickly modified the direct supervision guidelines to permit the supervising skilled to be distant and use real-time, interactive audio-video expertise. That change didn’t require the skilled’s real-time presence at, or stay commentary of, the service by way of interactive audio-video expertise all through the efficiency of the process.
This variation was short-term as a result of CMS was involved widespread direct supervision by means of digital presence is probably not secure for some medical conditions. In its proposed PFS rule, CMS rejected requests to make digital direct supervision a everlasting characteristic in Medicare. CMS is contemplating whether or not or not it ought to make digital direct supervision a everlasting characteristic of Medicare sooner or later sooner or later. stakeholders with information are invited to submit feedback and knowledge to CMS on this matter.
If the proposed rule is finalized, digital direct supervision will expire on the finish of the calendar 12 months wherein the PHE ends. If the PHE ends in October 2022, the supervision waiver will finish December 31, 2022. If the PHE ends in January 2023, the supervision waiver will finish December 31, 2023.
Postpone the Efficient Date of the Telemental Well being Six-Month Rule Till 151 Days After PHE Ends
In 2020, Congress imposed new circumstances on telemental well being protection below Medicare, creating an in-person examination requirement alongside protection of telemental well being companies when the affected person is positioned at dwelling. Below the rule, Medicare will cowl a telehealth service delivered whereas the affected person is positioned at dwelling if the next circumstances are met:
- The practitioner conducts an in-person examination of the affected person throughout the six months earlier than the preliminary telehealth service;
- The telehealth service is furnished for functions of analysis, analysis, or therapy of a psychological well being dysfunction (apart from for therapy of a identified substance use dysfunction (SUD) or co-occurring psychological well being dysfunction); and
- The practitioner conducts no less than one in-person service each 12 months of every follow-up telehealth service.
For a full understanding of the rule, learn the continuously requested questions and what it means for practitioners at Medicare Telehealth Psychological Well being FAQs.
This rule was initially scheduled to take impact the day after the PHE expires. Following an modification to the rule, it’s now set to take impact 151 days after the PHE expires.
Lengthen Protection of the Non permanent Telehealth Codes Till 151 Days After the PHE Ends
Non permanent telehealth codes are these companies added to the Medicare Telehealth Companies Checklist throughout the PHE on a short lived foundation, however which weren’t positioned into Class 1, 2, or 3. Protection of these short-term telehealth codes had been scheduled to finish when the PHE expires.
In its proposed PFS rule, CMS states it’s going to lengthen protection of these short-term telehealth codes till 151 days after the PHE ends. CMS is doing so for consistency with the Consolidated Appropriations Act, 2022 (CAA). CMS acknowledged this extension could simplify the post-PHE transition by making use of the identical protection finish date to all the varied waiver-related telehealth codes in a hope to cut back billing errors.
Observe, the Class 3 codes are set to run out December 31, 2023, whereas the opposite short-term telehealth codes are set to run out 151 days after the PHE ends. This implies, below the proposed rule, if the PHE ends after August 2023, the Class 3 codes would expire earlier than the short-term telehealth codes. If finalized, well being care suppliers would wish to maintain a cautious eye on the calendar to make sure billing practices sustain with the varied sundown dates.
Add 54 Codes to the Class 3 Telehealth Checklist
CMS’ Class 3 checklist incorporates companies that possible have a medical profit when furnished by way of telehealth, however lack ample proof to justify everlasting protection. CMS proposed including 54 codes to that Class 3 checklist. The companies fall into 9 classes: (1) remedy; (2) digital evaluation of implanted neurostimulator pulse generator/transmitter; (3) adaptive habits therapy and habits identification evaluation; (4) behavioral well being; (5) ophthalmologic; (6) cognition; (7) ventilator administration; (8) speech remedy; and (9) audiologic. The whole checklist will be discovered at this hyperlink.
Remember, these codes will expire December 31, 2023. Class 3 codes had been initially slated to run out on the finish of the 12 months wherein the PHE ends, however CMS prolonged protection of these codes by means of December 31, 2023. On this 12 months’s proposed PFS rule, CMS declined any additional extension, so all Class 3 codes will expire on the finish of 2023. Within the occasion the PHE extends nicely into 2023, CMS mentioned it’s going to contemplate an extra extension of the Class 3 codes at the moment.
What to Do Subsequent?
Suppliers, services, expertise corporations, and digital care entrepreneurs thinking about modifications to the telehealth codes for 2023 ought to contemplate offering feedback to the proposed rule. CMS is soliciting feedback on the proposed rule till 5:00 p.m. ET on September 6, 2022. Anybody could submit feedback – anonymously or in any other case – by way of digital submission at this hyperlink. Alternatively, commenters could submit feedback by mail to:
- Common Mail: Facilities for Medicare & Medicaid Companies, Division of Well being and Human Companies, Consideration: CMS-1770-P, P.O. Field 8016, Baltimore, MD 21244-8016.
- Specific In a single day Mail: Facilities for Medicare & Medicaid Companies, Division of Well being and Human Companies, Consideration: CMS-1770-P, Mail Cease C4-26-05, 7500 Safety Boulevard, Baltimore, MD 21244-1850
If submitting by way of mail, please be sure you permit time for feedback to be acquired earlier than the cut-off date.
Wish to Study Extra?
For extra data on telemedicine, telehealth, digital care, distant affected person monitoring, digital well being, and different well being improvements, together with the group, publications, and consultant expertise, go to Foley’s Telemedicine & Digital Well being Business Crew.