Reprinted from AAFP
The COVID-19 pandemic spurred an unprecedented expansion in the use of telemedicine, which policymakers encouraged by easing rules and restrictions. Though the COVID-19 public health emergency (PHE) officially expired May 11, many of those flexibilities remain in place for now. Here’s an overview of what has changed and what hasn’t.
When the COVID-19 public health emergency (PHE) expired May 11, many temporary policies initiated in response to the pandemic ceased or began to be phased out. This series intends to help practices weather the transition:
- Medicaid continuous coverage “unwinding”
- Expiration of HIPAA enforcement discretion
Medicare telehealth coverage
Medicare’s coverage of telehealth for outpatient services will largely remain the same after the Consolidated Appropriations Act of 2023 (CAA) extended many telehealth flexibilities through the end of 2024. The originating and geographic site restrictions have not been restored, meaning patients may continue to receive telehealth services no matter where in the United States they live, and they may receive services in their home rather than going to a health care facility. The CAA also extended Medicare’s coverage of certain audio-only services, including telephone evaluation and management (E/M) services (CPT codes 99441-99443).
A list of Medicare’s covered telehealth services is available to download and includes services that can be provided via audio-only technology. Medicare plans to revisit the list in its 2024 physician fee schedule. Although private insurers often follow Medicare’s lead, some may decide to alter their PHE-era telehealth coverage policies earlier.
Medicare’s coverage of hospital-based telehealth services did change with the end of the PHE, which triggered the expiration of the “Hospitals Without Walls” initiative. This means hospitals are no longer allowed to bill for the originating site facility fee (HCPCS code Q3014), clinic visit (HCPCS G0463), and remote mental health services (HCPCS codes C7900-C7902) unless the patient is located within a hospital and receives the service from an eligible distant site clinician.
Telehealth payment parity
Medicare will continue to pay telehealth services at the same rate as if the service had been provided in-person through the end of 2023. Additionally, it will continue to pay for telephone E/M services (CPT codes 99441-99443) at parity with office visit established patient E/M codes of comparable length. Medicare payment rates can be found using the Medicare Physician Fee Schedule Look-up Tool.
Barring regulatory changes, Medicare will revert to its pre-PHE telehealth payment rates on Jan. 1, 2024, meaning telehealth services will be paid at the facility rate rather than the non-facility rate. The Centers for Medicare & Medicaid Services (CMS) has not indicated whether it will change this policy, but more information should be available in the 2024 Medicare Physician Fee Schedule.
Prescribing controlled substances
The Drug Enforcement Administration and Substance Abuse and Mental Health Services Administration have extended all telemedicine flexibilities regarding prescribing controlled substances through Nov. 11, 2023. Clinician-patient telemedicine relationships established before Nov. 11, 2023, will have an additional year (until Nov. 11, 2024) to continue using telemedicine flexibilities for controlled medications that were in place during the COVID-19 PHE.
- FAQ: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency (CMS)
- COVID-19 FAQ on Medicare Fee-for-Service Billing (CMS)
- Medicare List of Telehealth Services (CMS)
- Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19 (CMS)
- Telehealth Licensure (HHS)
- Medicare Physician Fee Schedule Look-up Tool
- AAFP’s Resident Supervision Post-PHE (PDF)
- AAFP and CMS Discuss PHE Unwinding (Webinar)
- Medicare Telehealth/Connected Health Waivers Post-PHE (CCHP)
- Billing and Coding Medicare Fee-for-Service claims (HHS)
- Telehealth Controlled Substance Rx Flexibilities Extended – AAFP News
- Rural Health Clinics and Federally Qualified Health Centers: CMS Flexibilities to Fight COVID-19
— Erin Solis, Manager of AAFP Center for Payment and Practice Innovation