Oncology & Hematology Coding Alert

Make sure you have all these deadlines in your 2023 calendar.

On Jan. 30, 2023, the Biden administration announced that the COVID-19 public health emergency (PHE) will end on May 11, 2023. However, the PHE’s end does not mean the end of confusion regarding which CMS telehealth waivers will expire, which will phase out over time, and which will be permanent.

Here, we’ll break it all down for you to make a smooth post-PHE telehealth transition.

Know How Medicare Will Handle Telehealth Moving Forward

Some PHE telehealth waivers are now going to be permanent. For example, the Consolidated Appropriations Act of 2021 expanded access to telehealth services, which “have been so important to the health and well-being of Americans affected by COVID-19,” says CMS.

Currently, this means the following telehealth flexibilities are going to continue through December 31, 2024:

• “People with Medicare can access telehealth services in any geographic area in the United States, rather than only those in rural areas.
• People with Medicare can stay in their homes for telehealth visits that Medicare pays for rather than traveling to a health care facility.
• Certain telehealth visits can be delivered audio-only (such as a telephone) if someone is unable to use both audio and video, such as a smartphone or computer” (www.cms.gov/files/document/what-do-i-need-know-cms-waivers-flexibilities-and-transition-forward-covid-19-public-health.pdf).

Medicare will continue to cover audio-only services — 99441 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services …; 5-10 minutes of medical discussion), 99442 (… 11-20 minutes of medical discussion), or 99443 (… 21-30 minutes of medical discussion) — but only until the PHE flexibilities end. At that point, “CMS will once again assign the telephone E/M services a ‘bundled’ status, which means Medicare will no longer separately pay for them,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

Post-PHE telehealth POS: Per the calendar year (CY) 2023 Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule (PFS) final rule, you’ll “continue to bill with the place of service (POS) indicator that would have been reported had the service been furnished in-person … through … the end of CY 2023” (www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule).

Then, beginning Jan.1, 2024, you’ll use new modifier POS 10 (Telehealth provided in patient’s home) in addition to POS 02 (Telehealth provided other than in patient’s home) or modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) “for telehealth services rendered on patients receiving such services from home.”

Additionally, since Jan. 1, 2023, you have been able to use CPT modifier 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system) or Medicare modifier FQ (This service was furnished using audio-only communication technology) as appropriate “for services furnished using audio-only communications technology” per the final rule (www.govinfo.gov/content/pkg/FR-2022-11-18/pdf/2022-23873.pdf).

Watch the HIPAA Compliance Waiver Wind Down

During the PHE, the U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) “exercised HIPAA enforcement discretion,” turning a blind eye to providers’ use of popular, non-HIPAA compliant platforms such as Zoom and Facebook Messenger in providing audio and visual telehealth services.

However, on April 11, 2023, OCR announced that it was going to end this enforcement discretion for healthcare providers offering audio and visual telehealth services on non HIPAA-compliant platforms. In a press release, OCR announced it will be “providing a 90-calendar day transition period for covered health care providers to come into compliance with the HIPAA Rules with respect to their provision of telehealth. The transition period will be in effect beginning on May 12, 2023, and will expire at 11:59 p.m. on August 9, 2023.”

During the 90-calendar day transition period, “OCR will continue to exercise its enforcement discretion and will not impose penalties on covered health care providers for noncompliance with the HIPAA Rules that occurs in connection with the good faith provision of telehealth” (www.hhs.gov/about/news/2023/04/11/hhs-office-for-civil-rights-announces-expiration-covid-19-public-health-emergency-hipaa-notifications-enforcement-discretion.html).

Revert Back to Pre-PHE State Licensure Laws

During the PHE, the federal government waived state licensure requirements, allowing providers to practice telehealth across state lines. This waiver will end on May 11, 2023.

For some states, the change back to pre-PHE licensure policies is unnecessary, as they never adopted licensure waivers to begin with. For others, the transition began some time ago because the state PHE ended before the federal PHE.

“Indiana is a prime example” of the latter, says attorney Robert Markette Jr. with Hall Render in Indianapolis. “We are a licensure state. At the beginning of the pandemic, the state moved to waive certain licensure requirements. When the state ended the PHE last year, all of the state license waivers went away. This meant providers had to return to following state licensure requirements without the waivers. At that point, the CMS waivers did not matter,” Markette says.

Note These New RPM New Patient Rules

During the PHE, CMS allowed clinicians to bill for remote physiologic monitoring (RPM) services rendered for new or established patients for both acute and chronic conditions. Once the PHE ends, clinicians must have an established relationship with the patient prior to providing these services.

Additionally, right now, the RPM process, as described by CPT^® codes 99453 (Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment) and 99454 (… device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days), allows clinicians to report those codes with only two days of data for patients suspected of or having confirmed cases of COVID-19. Once the PHE ends, clinicians can report those codes only if they have at least 16 days of data collected.