2023 Changes in Telehealth Services Finalized by CMS

2023 Changes in Telehealth Services Finalized by CMS

Telemedicine services have increased more than 30 fold since the onset of the COVID-19, Public Health Emergency (PHE). Despite the fact that, the PHE has begun to wind down and telemedicine waivers are nearing their end, digital health modalities remain relevant. It is important to ensure appropriate access to telehealth services to know changes in telehealth services. On November 1, 2022, the Centers for Medicare, and Medicaid Services (CMS) released its final 2023 Medicare Physician Fee Schedule.

Some of the most prominent telehealth policy changes in telehealth services include:

  1. Discontinuing reimbursement of telephone (audio-only) E/M (Evaluation and Management) services.
  2. Discontinuing the use of virtual direct supervision.
  3. Five new changes in telehealth services codes for prolonged E/M services and chronic pain management.
  4. Postponing the effective date of the telemental health six-month rule until 151 days after the PHE ends.
  5. Extending coverage of the temporary telehealth codes until 151 days after the PHE ends.
  6. Addition of 54 codes to the category 3 telehealth list, and modifying their expiration to the end of 2023, or 151 days after the PHE ends.

Discontinuing reimbursement of telephone (audio-only) E/M services

Under the PHE waivers, CMS allowed separate reimbursement for telephone (audio- only) E/M services. The codes applied for this ranged from 99441 to 99443. This was embraced by many practitioners and patients and particularly patients in rural areas with inadequate access to internet services or those who lack digital literacy. However, CMS believes that changes in telehealth services must be analogous to in-person care which essentially makes it a substitute for a face-to-face encounter.

Since audio-only telephone is inherently non-face-to-face, the modality fails to meet the statutory standard. As a result, 151 days after the PHE expires, with the exception of certain mental health telehealth services, audio only E/M services will revert to its previous bundled status under Medicare; which means that while it remains payable, it will no longer be covered separately.

Discontinuing the use of virtual direct supervision for changes in telehealth services

Under Medicare part B, certain types of services such as diagnostic tests or services incident to practitioner’s professional services, needed to be furnished under the direct supervision of the practitioner. This meant that, the practitioner had to be physically present in the same office suite as the supervisee and be immediately available for any assistance or input. While the practitioner need not be in the same room, immediate availability indicates physical presence and not virtual availability.

However, at the time of PHE waivers, changes in telehealth services from CMS temporarily changed the direct supervision rule to allow the practitioner to remain virtually or remotely available using interactive audio- visual tech. But there was the fear that direct supervision via virtual availability might not be appropriate in certain clinical situations. Thus, in the final rule, CMS rejected the proposition to accept virtual direct supervision as a permanent feature of Medicare. Hence, virtual direct supervision will expire at the end of the calendar year in which the PHE ends.

Five new telehealth codes for prolonged E/M services and chronic pain management


CMS has proposed five new telehealth codes to be added to the Medicare telehealth services on a permanent basis.

G0316

for prolonged hospital inpatient or observation care E/M service(s) extending beyond the total time for the primary service (where the primary service has been selected using time on the date of the primary service), each additional 15 minutes by the physician or QHP, with or without direct patient contact. List separately in addition to CPT codes 99223, 99233, and 99236 for hospital inpatient or observation care E/M services.

G0317

for prolonged nursing facility E/M service(s) extending beyond the total time for the primary service (where the primary service has been selected using time on the date of the primary service), each additional 15 minutes by the physician or QHP, with or without direct patient contact. List separately in addition to CPT codes 99306, 99310 for nursing facility E/M services.

G0318

for prolonged home or residence E/M service(s) extending beyond the total time for the primary service (where the primary service has been selected using time on the date of the primary service), each additional 15 minutes by the physician or QHP, with or without direct patient contact. List separately in addition to CPT codes 99345, 99350 for home or residence E/M services.

G03002

for chronic pain management and treatment, monthly bundle including diagnosis, assessment and monitoring, administration of a validated pain rating scale or tool, the development, implementation, revision, and/or maintenance of a patient-centric care plan that includes strengths, goals, clinical needs, desired outcomes along with overall treatment management, facilitation and coordination of any necessary behavioral health treatment, medication management, counseling, any crisis care pertaining to chronic care and ongoing communication between involved practitioners as required.  A minimum initial 30-minute face-to-face visit personally provided by a physician or other QHP, per calendar month is required. When using G3002, 30 minutes must be either met or exceeded

G3003

Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. List separately in addition to code for G3002. When using G3003, 15 minutes must be met or exceeded.

Postponing the effective date of the telemental health six- month rule until 151 days after the PHE ends.

In 2020, Congress imposed a new set of conditions, wherein they agreed to cover telemental health services for a patient located at home, if the following conditions are met:

  1. The practitioner conducts and in- person examination of the patient 6 months prior to the initial telehealth service
  2. The changes in telehealth services are furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder – not including treatment for a diagnosed substance use disorder; SUD or a co-occurring mental health disorder.)
  3. The practitioner conducts at least one in-person service every 12 months of a follow-up changes in telehealth services.

Initially this changes in telehealth services were to be implemented from the day after the expiration of the PHE but will now take effect 151 days after the PHE expires.

Extending coverage of the temporary telehealth codes until 151 days after the PHE ends.

Temporary telehealth codes for changes in telehealth services refer to the codes that were added on a temporary basis during the PHE and were not placed into category 1, 2, or 3. These codes were scheduled to end with the expiration of the PHE.   In the final PFS rule, CMS announced the coverage of the temporary changes in telehealth services codes until 151 days after the expiry of the PHE.

Addition of 54 codes to the Category 3 telehealth list, and modifying their expiration to the end of 2023 or 151 days after the PHE ends.

CMS has added additional services to the Medicare changes in Telehealth Services list on a Category 3 basis and extended the expiration of these codes by modifying their expiry to last till the later end of 2023 or 151 days after the end of the PHE. The 54 codes added to the Category 3 list fall into 9 categories:

1. Therapy
2. Electronic analysis of implanted neurostimulator pulse generator
3. Adaptive behavior treatment and behavior identification assessment
4. Behavioral health
5. Ophthalmologic
6. Cognition
7. Ventilator management
8. Speech therapy
9. Audiologic.

The complete list of codes can be found here. 2023 brings with it, a host of changes in telehealth services. EMPClaims is here to help you stay updated and prepare in advance.

Spread the love
Facebook
Twitter
LinkedIn
Pinterest

Leave a Reply

Your email address will not be published. Required fields are marked *