Top Telehealth Takeaways from the 2024 Proposed Medicare Physician Fee Schedule
At the end of 2021, Congress enacted the 2022 Consolidated Appropriations Act which extended certain telehealth flexibilities introduced during the COVID-19 Public Health Emergency (the “PHE”) for 151 days following the end of the PHE. Then, in December 2022, the 2023 Consolidated Appropriations Act (the “2023 CAA”) further extended these flexibilities through the end of 2024. While Congress continues to assess much-needed permanent change federal telehealth policy, industry stakeholders have been anxiously awaiting an update from the Centers for Medicare and Medicaid Services (“CMS”).
Now, in the first proposed Medicare Physician Fee Schedule (“MPFS”) since the PHE ended on May 11, 2023, CMS is clearing up some lingering unanswered questions and streamlining its processes.
Proposed Revisions to Medicare Telehealth Rules for 2024
CMS proposes to extend all remaining telehealth flexibilities through the end of 2024
Under the 2024 MPFS Proposed Rule (“Proposed Rule”), CMS proposes to implement rules enacted in the 2023 CAA and extend the following telehealth flexibilities through December 31, 2024:
Suspension of originating site requirements to allow providers to bill for services delivered to patients located at any site in the United States, including their home, during a telehealth visit;
Occupational therapists, physical therapists, speech-language pathologists, and audiologists can provide and bill for telehealth services;
FQHCs and RHCs can provide and bill for telehealth services furnished to patients in their homes or other locations within the United States;
Physicians, mental health practitioners, FQHCs, and RHCs can initiate tele-behavioral health services without a prior in-person visit; and
Continued coverage of telehealth services included on the Medicare Telehealth Services List as of March 15, 2020.
CMS declines all outside requests to permanently add CPT codes to the Telehealth List
Although CMS received several requests to permanently add certain CPT codes to the list of codes eligible to be provided via telehealth (the “Telehealth List”), CMS opined in the Proposed Rule that none of the requested codes meet the requirements for permanent addition. Specifically, CMS received requests to add the following codes to the list:
Cardiovascular Procedures (CPT code 93793)
Cardiovascular and Pulmonary Rehabilitation (CPT codes 93797 and 94625)
Deep Brain Stimulation (CPT codes 95970, 95983, and 95984)
Therapy (CPT codes 90901, 97110, 97112, 97116, 97161, 97162, 97163, 97164, 97530, 97750, and 97763)
Hospital Care, Emergency Department and Hospital (CPT codes 99221, 99222, 99223, 99234, 99235, 99236, 99238, 99239, 99281, 99282, and 99283)
Health and Well-Being Coaching (CPT codes 0591T, 0592T, and 0593T)
Though CMS did not propose to permanently add any of these codes to the Telehealth List, they did propose to keep them there through December 31, 2024.
With respect to the Therapy codes requested, CMS believes that permanently adding them to the Telehealth List would create confusion among stakeholders if Congress does not permanently allow PTs and OTs to provide telehealth services. Perhaps if Congress makes this change before the end of 2024, CMS will reconsider this request.
The Health and Well-Being Coaching codes are not currently on the Telehealth List and, upon review, CMS believes there is not yet enough evidence to support permanent addition. However, they are adding the codes to the Telehealth List on a temporary basis in hopes that available evidence will evolve to potentially support permanent addition in the future.
Proposed addition of HCPCS code GXXX5
Despite declining all outside requests for permanent additions to the Telehealth List, CMS itself proposed new HCPCS code GXXX5 for permanent addition. As proposed, HCPCS code GXXX5 would provide payment for “Administration of a standardized, evidence-based Social Determinants of Health Risk Assessment tool, 5-15 minutes.” The service would need to be furnished on the same date as an E/M visit and would be reasonable and necessary only when used to inform the patient’s diagnosis and treatment plan established during that visit.
A new and improved process for requesting additions to the Telehealth List
Perhaps the most notable proposed revision related to Telehealth in the Proposed Rule is a new-and-improved process for requesting additions to the Telehealth List. CMS proposed a revamped, binary classification system that would entirely replace the existing 3-category system currently in place. The new system would allow CMS discretion to determine, on a case-by-case basis, whether to add a code to the Telehealth List on a permanent or provisional basis.
The new process would consist of CMS completing the following 5 steps:
Determine whether the service is separately payable under the Physician Fee Schedule (“PFS”).
Determine whether the service is subject to the provisions of section 1834(m) of the Social Security Act. This step determines whether a service is inherently face-to-face and therefore appropriate to classify as “telehealth”. CMS distinguishes services subject to section 1834(m) from those services that are inherently non-face-to-face, such as remote patient monitoring and chronic care management, which are not appropriate for addition to the Telehealth List.
Determine whether each element of the relevant HCPCS/CPT code is capable of being furnished using an interactive telecommunications system.
Consider whether the service elements of the requested service map to the service elements of a service that was added on a permanent basis in previous rulemaking. CMS hopes this step will reduce administrative burden as any code that “maps” to a permanent status code will be added on a permanent basis to the Telehealth List.
Consider whether there is evidence of clinical benefit analogous to the clinical benefit of the in-person service if furnished via telehealth.
Upon completing these five steps, CMS would add a service on a “permanent” basis if the service elements map to the service elements of a service that was added on a permanent basis in previous rulemaking (Step 4). CMS would add a service on a “provisional” basis if there is evidence of clinical benefit analogous to the clinical benefit of the in-person service when the service is furnished via telehealth (Step 5). CMS would monitor provisional services and could, at its discretion based on evolving clinical evidence, either upgrade a service from provisional to permanent or remove the service from the list in the future.
Place of Service 10 to be paid at the national non-facility rate
CMS is proposing to recognize Place of Service 10 (the patient’s home) for the first time and, importantly, proposes to reimburse telehealth services billed under POS-10 at the national non-facility rate. Previously, telehealth services were billed under Place of Service 2 and reimbursed at the facility rate, which is often lower than the non-facility rate.
Key Takeaways
Stakeholders will be pleased that CMS addressed many of the outstanding telehealth questions that arose following the expiration of the PHE. Of note:
It is good news that CMS has proposed to implement the provisions of the 2023 CAA and extend telehealth flexibilities through the end of 2024. However, some uncertainty remains as industry awaits permanent action from Congress to address telehealth expansion.
A streamlined review process may offer more predictability for stakeholders as CMS adds clarity to the process for adding services to the Telehealth List.
Place of Service 10 sustains parity for Medicare telehealth services, providing reimbursement to providers at the same rate they would be paid if they provided the same service in-person in their office.
Public comments are due September 11th at 5pm
CMS is accepting public comment on the above proposals through 5 p.m. ET on September 11, 2023. If you have feedback for CMS and are interested in submitting comments to this Proposed Rule, we’re here to help! The due date is quickly approaching, so please contact us as soon as possible to learn more.