CMS is finally giving providers some insight into the future of Public Health Emergency (PHE) Telehealth waivers as they’re set to expire. Many providers have taken advantage of the Telehealth waivers and should be prepared for what to do next if the CY 2021 Medicare Physician Fee Schedule (MFPS) rule is finalized with the Telehealth changes currently proposed. The CY 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule offers some good news for providers as CMS is indicating that it does not intend to completely roll back all of the waivers implemented during the PHE.

However, CMS does not intend to permanently provide all current telehealth flexabilities, but is asking for comments on certain telehealth changes such as audio-only technology and additional services to permanently add to the Medicare Telehealth Services List. This is a promising opportunity for providers to indicate new avenues of telehealth not previously allowed. Advis is encouraging providers to take advantage of this opportunity to voice to CMS the importance of more telehealth access, especially with the ongoing effects of the pandemic.

In its previous posts Advis summarized the wide expansion of telehealth regulations during the PHE. Below, Advis summarizes the proposed permanent changes and areas where CMS is requesting comments. The deadline to submit comments is October 5, 2020. Our experts stand ready to assist you in any way necessary.

Patient’s Home as Originating Site

CMS intends to roll back the broad flexibility for the patient’s home to be an eligible originating site. Instead, CMS is proposing certain services which allow for home visits to be temporarily added to the Medicare Telehealth Services List and potentially permanently added. However, CMS is not requesting comments on whether the patient’s home should become a permanent eligible originating site.

Use of Audio-Only Technology

During the PHE, CMS implemented waivers to allow providers to furnish E/M services through the use of audio-only technology, rather than requiring both audio and video technology. In the Proposed Rule, CMS explains it does not have the authority to waive this requirement outside of the PHE.

However, recognizing that longer conversations may be required to determine whether the patient needs a face-to-face visit with a provider, CMS seeks comments addressing whether it should develop separate services and HCPCS codes, which would be similar to a virtual check-in (brief 5-10-minute conversation between provider and established patient) to determine if additional care is needed via audio and/or video technology. CMS intends the duration of the visits to extend beyond the 5-10 minute virtual check-in. CMS requests input on what would be an appropriate amount of time for these codes. Additionally, CMS is seeking comments on whether the separate codes and payments would be temporarily used for a set time after the PHE ends or if they should be permanently allowed.

Telehealth Services to become Permanent following the PHE

CMS will also be permanently adding some services first allowed during the PHE to the Medicare Telehealth Services list, including:

  • Group Psychotherapy – 90853
  • Domiciliary, Rest Home, or Custodial Care services, Established Patients – 99334-99335
  • Home Visits, Established Patient – 99347- 99348
  • Cognitive Assessment and Care Planning Services – 99483
  • Visit Complexity Inherent to Certain Office/Outpatient E/Ms – HCPCS GPC1X
  • Prolonged Services – 99XXX
  • Psychological and Neuropsychological Testing – 96121

Temporary Telehealth Services to Expire with the PHE

CMS states as well that the services listed below will temporarily remain on the Medicare Telehealth Services List through the calendar year the PHE ends, including:

  • Domiciliary, Rest Home, or Custodial Care services, Established patients – 99336 and 99337
  • Home Visits, Established Patients – 99349 and 99350
  • ED Visits – 99281-99283
  • Nursing Facilities Discharge Day Management – 99315 and 99316
  • Psychological and Neuropsychological Testing – 96130-96133

Telehealth Services for which CMS is Requesting Comments

CMS is requesting comments on whether the telehealth services listed below should be added permanently to the Medicare Telehealth Services list based on criteria outlined by CMS in the Proposed Rule (e.g., who provides the service, what are the practice safeguards employed, health outcomes, etc.).

CMS is requesting comments on whether all aspects of each service can be furnished via two-way audio and visual technology. CMS noted specifically the inclusion of therapy services; it is seeking comments on the impact of allowing providers such as PTs, OTs, and SPLs to permanently provide telehealth services. The list of services to be commented upon includes:

  • Initial nursing facility visits, all levels (Low, Moderate, and High Complexity) – 99304-99306
  • Psychological and Neuropsychological Testing – 96136-96139
  • Therapy Services, Physical and Occupational Therapy, All levels – 97161- 97168; 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507
  • Initial hospital care and hospital discharge day management – 99221-99223; 99238- 99239
  • Inpatient Neonatal and Pediatric Critical Care, Initial and Subsequent – 99468- 99472; 99475- 99476
  • Initial and Continuing Neonatal Intensive Care Services – 99477-99480
  • Critical Care Services – 99291-99292
  • End-Stage Renal Disease Monthly Capitation Payment codes – 90952, 90953, 90956, 90959, and 90962
  • Radiation Treatment Management Services – 77427
  • Emergency Department Visits, Levels 4-5 – 99284-99285
  • Domiciliary, Rest Home, or Custodial Care services, New – 99324-99328
  • Home Visits, New Patient, all levels – 99341- 99345
  • Initial and Subsequent Observation and Observation Discharge Day Management – 99217- 99220; 99224- 99226; 99234-99236

Advis commends CMS on its efforts to safely enhance Medicare telehealth services. Advis also encourages providers to submit comments to CMS in advance of the October 5th deadline. By submitting comments, providers will help ensure that meaningful telehealth changes remain permanent even after the end of the PHE. As always, Advis is available to assist you in drafting and submitting comments to CMS. Contact an expert online or call 708-478-7030.

Published: August 6, 2020