AASM has continued to advocate for CMS to make the telehealth coverage permanent, since the addition of many services to the telehealth list, due to the COVID-19 public health emergency. While CMS has not finalized making telehealth coverage permanent, as requested, the agency has instead finalized a proposal to extend telehealth coverage for an additional five months beyond the end of the public health emergency for all codes that will be on the telehealth list. CMS also finalized maintaining the same payment rates for office visits provided in-person or via telehealth through the end of 2023 instead of reducing payments for telehealth visits to the facility rates.
Telephone E/M Services
Despite advocacy from several medical organizations, including AASM, urging CMS to permanently add Telephone (audio only) E/M services (99441 – 99443) to the telehealth services list, CMS finalized their decision not to add these services to the Medicare Telehealth Services List. However, the agency noted that these codes will be reverted back to bundled status after the expiration of the 151-day period following the end of the public health emergency.
Emotional/Behavior Assessment Psychological or Neuropsychological Testing and Evaluation Services
AASM encouraged CMS to permanently add the emotional/behavior assessment psychological or neuropsychological testing and evaluation services codes (97151-97158, 0362T, and 0373T) to the Telehealth Services list. CMS has instead decided to add these codes to the Medicare Telehealth Services List on a Category 3 basis, to allow for the collection and evaluation of data that could potentially support permanent inclusion on the Medicare Telehealth Services List. The agency will evaluate the data in the future, before making a final decision regarding these codes.
Use of Modifiers for Medicare Telehealth Services Following the End of the COVID-19 Public Health Emergency
CMS finalized that Practitioners can continue to bill with modifier 95 along with the POS code corresponding to where the service would have been furnished in-person through the later of the end of the year in which the public health emergency ends or CY 2023. All services furnished in a facility as an originating site, POS 02 may be used, and the corresponding facility fee can be billed, per pre-public health emergency policy, beginning the 152nd day after the end of the public health emergency. Additionally, effective January 1, 2023, CPT modifier 93 will be able to be added, as appropriate, for services furnished using audio-only communications technology. All providers must append Medicare modifier FQ (Medicare telehealth service was furnished using audio-only communication technology) for allowable audio-only services furnished in those settings. However, CMS is also finalizing a requirement that all providers use modifier 93 when billing for eligible mental health services furnished via audio-only telecommunications technology. Providers have the option to use the FQ or 93 modifiers or both where appropriate and true, since they are identical in meaning. Supervising will continue to be required to append the FR modifier on any applicable telehealth claim when they provide direct supervision for a service using virtual presence through real-time, audio and video telecommunications technology. CMS is also finalizing that, for Medicare telehealth services, the agency will continue to maintain payment at the POS had the service been furnished in-person, and this will allow payments to continue to be made at the non-facility-based rate for Medicare telehealth services through the latter of the end of CY 2023 or the end of the calendar year in which the public health emergency ends.
Expiration of Public Health Emergency Flexibilities for Direct Supervision Requirements
CMS is reviewing their current temporary policy to permit immediate availability for purposes of direct supervision through the virtual presence of the billing clinician, which was adopted to address the circumstances of the public health emergency for COVID-19. While AASM advocated for the public health emergency flexibilities to be made permanent with the exception of high-risk patients, the AASM is encouraged by CMS allowing additional time to collect information and evidence for direct supervision through virtual presence to gain a better understanding of the potential circumstances in which this flexibility could be appropriate permanently, outside of the public health emergency for COVID-19. CMS will revisit at a later date.