Modifiers for Expanded Mental Health Coverage via Telehealth

CMS recently released an MLN Matters article discussing several updates, including an update to the Telehealth Services List and two additional modifiers for the CY 2022 Medicare Physician Fee Schedule.

The Consolidated Appropriations Act of 2021 expanded mental health services through telehealth beyond rural America and removed residential geographic restrictions. The Act also added the home of the beneficiary as a permissible originating site for telehealth services for all those seeking diagnosis, evaluation, or treatment of a mental health disorder, including substance abuse disorders. Medicare previously covered telehealth services within a very narrow window of eligibility. Geographic restrictions limited coverage to beneficiaries residing in rural areas who reported to a health facility originating site to receive telehealth services. Additionally, CMS has now expanded its definition of interactive telecommunications systems to include audio-only communications technology when furnished to established mental health patients in their homes where the patient does not have the technical capacity or availability of real-time audio and visual telecommunications, or if the patient does not consent to the use of real-time video technology.

For new or established mental health patients to continue utilizing Telehealth Mental Health services after the Public Health Emergency (PHE) ends, CMS will require an in-person, non-telehealth visit with the physician or practitioner within six months of the initial telehealth service. For established patients, this visit must occur no later than six months after the end of the PHE. A subsequent in-person, non-telehealth visit must occur within 12 months of the initial six-month visit, and at least every 12 months thereafter (exceptions may be made based on beneficiary circumstances that are documented in the patient’s medical record). More frequent in-person visits are allowed as needed on a case-by-case basis.

Multiple telehealth services payable under the Medicare Physician Fee Schedule have been added to the CY2022 list. Some services are available up through December 31, 2023, while others state that they are a temporary addition for the length of the current PHE. Two additional telehealth mental health services modifiers were also introduced:

  • FQ – A telehealth service was furnished using real-time audio-only communication technology.
  • FR – A supervising practitioner was present through a real-time two-way, audio/video communication technology.

With so many pushing for the continuation of the telehealth expansion we are experiencing as a result of the PHE, it is a positive sign to see some telehealth coverage expanding beyond the scope of the pandemic. CMS is listening to healthcare leaders across the country who recognize that increased Mental Health Telehealth services fill a gap in care and treatment for current Medicare beneficiaries who require treatment for a plethora of mental health disorders.

Please contact an Advis expert today for more on this important update.

Published: February 10, 2022