CMS has released its CY 2021 Medicare Physician Fee Schedule Final Rule. The rule begins to permanently expand a portion of the telehealth regulations initially implemented as a result of the COVID-19 Public Health Emergency (“PHE”). Yet, absent Congressional action, CMS notes at the same time its lack of statutory authority to finalize many contingent features, such as rolling back geographic limitations for Medicare beneficiaries, permanently allowing audio-only telehealth services, and permanently allowing ancillary providers (such as PTs, OTs, SPLs, etc.) to provide and bill for telehealth services. It appears that post-PHE, movement at the Congressional level may be required for additional meaningful expansions of telehealth for non-rural providers.

Below, Advis summarizes key impacts of the Final Rule, including where CMS requests additional commentary to gather more data from providers.

Geographic Restrictions

CMS did not expand the geographic region or permanently remove the geographic restrictions that limit telehealth to Medicare beneficiaries in rural areas. Rather, CMS notes its limitations due to telehealth regulations within the Social Security Act. The geographic restrictions will most likely not be changed or expanded in the future without additional Congressional action. Without such action, the prior geographic limitations will once again apply at the end of the PHE.

The restriction states that to receive telehealth services a patient must be located in either (1) a county outside a Metropolitan Statistical Area (MSA) or (2) a rural Health Professional Shortage Area (HPSA) in a rural census tract.

Audio Only Telehealth Services

CMS will not finalize separate payment for audio-only telehealth services following the conclusion of the PHE. CMS did not propose to add audio-only services on a permanent or temporary basis to the Medicare Telehealth Services list because it would not have the authority to waive the audio and video technology requirement outside of the PHE. However, as noted in the next section, CMS takes steps towards adding more audio-only services in the future as virtual check-ins rather than telehealth services.

Interim Final Rule with Comment Period for Coding and Payment of Virtual Check-In Services

Although CMS is not continuing separate payment for E/M audio-only telehealth services once the PHE ends, CMS finalized establishing an audio-only assessment service on an interim basis for calendar year 2021.

During the PHE, rather than requiring both audio and video technology CMS implemented waivers to allow providers to furnish E/M services through the use of audio-only technology. In the Proposed Rule, CMS recognized that these longer conversations may be required to determine whether the patient needs a face-to-face visit with a provider.

Therefore, CMS is now finalizing this process on an interim basis to allow service for patients who may be reluctant to return to in-person visits following the conclusion of the PHE. This action will allow CMS to determine whether the code should be adopted on a permanent basis.

G2252 – Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.

This code will be used to determine if an in-person visit will be needed for the patient. Since it is not a service listed on the Medicare Telehealth Services List, the only technology requirement is that the communication technology must be synchronous (e.g. audio-only capable). The deadline to submit comments related to this interim final rule has not been published yet, but it will be 60 days after the date of filing for public inspection at the Office of the Federal Register, once that takes place.

Communication Technology-Based Services (CBTS) for Nonphysician Practitioners

CMS created two additional HCPCS G-codes to be billed by nonphysician practitioners (e.g., licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech-language pathologists) who cannot independently bill for E/M services. These codes will be identically valued to already established virtual check-in codes, G2010 and G2012. The two codes are listed below.

• • G2250 – Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment.
  • G2251 – Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

Permanent Additions to the Medicare Telehealth Services List

CMS will be permanently adding the services listed below to the Medicare Telehealth Services List. The addition of thesese services was either requested through CMS’ established process for adding services to the Medicare Telehealth Services List or they were added during the PHE.

• • Group Psychotherapy (CPT 90853)
  • Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT 99334-99335)
  • Home Visits, Established Patient (CPT 99347- 99348)
  • Cognitive Assessment and Care Planning Services (CPT 99483)
  • Visit Complexity Inherent to Certain Office/Outpatient E/Ms (HCPCS G2211)
  • Prolonged Services (HCPCS G2212)
  • Psychological and Neuropsychological Testing (CPT 96121)

Temporary Additions to the Medicare Telehealth Services List – Will Expire or be Permanently Added Post PHE

CMS states that the services listed below will temporarily remain on the Medicare Telehealth Services List through the end of the calendar year in which the PHE ends. CMS extended the availability of these services on the Medicare Telehealth Services List to give providers the opportunity to gather the data necessary to allow CMS to determine if the services should be permanently added to the list.

• • Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT 99336-99337)
  • Home Visits, Established Patient (CPT 99349-99350)
  • Emergency Department Visits, Levels 1-5 (CPT 99281-99285)
  • Nursing facilities discharge day management (CPT 99315-99316)
  • Psychological and Neuropsychological Testing (CPT 96130- 96133; CPT 96136- 96139)
  • Therapy Services, Physical and Occupational Therapy, All levels (CPT 97161- 97168; CPT 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507)
  • Hospital discharge day management (CPT 99238- 99239)
  • Inpatient Neonatal and Pediatric Critical Care, Subsequent (CPT 99469, 99472, 99476)
  • Continuing Neonatal Intensive Care Services (CPT 99478- 99480)
  • Critical Care Services (CPT 99291-99292)
  • End-Stage Renal Disease Monthly Capitation Payment codes (CPT 90952, 90953, 90956, 90959, and 90962)
  • Subsequent Observation and Observation Discharge Day Management (CPT 99217; CPT 99224- 99226)

Services that Will Not be Temporarily or Permanently Added to the Medicare Telehealth Services List after the PHE Ends

The below services were added to the Medicare Telehealth Services List during the PHE, but will not be extended on a permanent or temporary basis once the PHE expires.

• • Initial Nursing Facility Visits, All Levels (Low, Moderate, and High Complexity) (CPT 99304-99306)
  • Initial hospital care (CPT 99221-99223)
  • Radiation Treatment Management Services (CPT 77427)
  • Domiciliary, Rest Home, or Custodial Care services, New (CPT 99324- 99328)
  • Home Visits, New Patient, all levels (CPT 99341- 99345)
  • Inpatient Neonatal and Pediatric Critical Care, Initial (CPT 99468, 99471, 99475, 99477)
  • Initial Neonatal Intensive Care Services (CPT 99477)
  • Initial Observation and Observation Discharge Day Management (CPT 99218 – 99220; CPT 99234- 99236)
  • Medical Nutrition Therapy (CPT G0271)

For additional information or clarification regarding these matters, please contact Advis at your earliest convenience online or at 708.478.7030.

Published: December 2, 2020