Oncology & Hematology Coding Alert

And find out when, or if, the waivers will end.

Keeping track of the current state of telehealth during the COVID-19 public health emergency (PHE) is no easy task. And speculation about which services Medicare will continue to pay for — and which waivers they will eliminate — once the PHE officially expires continues among coders.

That’s why you likely have many telehealth questions. And that’s why we collected the most-asked questions and added our experts’ best answers to help you navigate Centers for Medicare & Medicaid Services’ (CMS’) current telehealth regulations and figure out if and how they will change and when that will happen.

Question: What telehealth services are Medicare currently paying for?

Answer: You can find the most recent list at www.cms.gov/Medicare/Medicare-General- Information/Telehealth/Telehealth-Codes. Some of the codes on the list relevant to oncology practices are 77427 (Radiation treatment management, 5 treatments) and 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) along with the current observation care discharge service code (99217), the current initial and subsequent observation care codes (99218-99220, 99224-99226), the current initial and subsequent hospital care codes (99221-99223, 99231-99233), the current observation or inpatient hospital care with same day admission and discharge codes (99234- 99236) and the current hospital discharge day management service codes (99238-99239).

However, as we have reported in previous issues of Oncology and Hematology Coding Alert, AMA revised many of these E/M CPT^® codes for 2023. AMA has deleted hospital observation codes 99218-99220, 99224-99226, and 99217; revised the inpatient and observation care codes into codes 99221-99223 (initial) and 99231-99233 (subsequent); and revised the inpatient/observation same-day discharge codes 99234-99236, effective Jan. 1, 2023.

Consequently, “as expected, CMS eliminated the observation codes mentioned above from the telehealth code list. Additionally, CMS eliminated +99356 [Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour] and +99357 [… each additional 30 minutes] from the telehealth list as CPT^® has eliminated these codes effective Dec. 31, 2022,” notes Kelly Loya, CPC, CHC, CRMA, CPhT, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services, Charlotte, North Carolina.

CMS and CPT^® have replaced the codes with 99418 (Prolonged inpatient or observation evaluation and management service(s) time ….) for non-Medicare patients and HCPCS Level II code G0316 (Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service …) for Medicare patients. As you would expect, G0316 is the only one of these two codes added to the 2023 telehealth list.

Coding alert: With the introduction of these codes, CMS and CPT^® have continued their disagreement about when you can apply the codes to the primary service. So, you should stay tuned to the next issue of Oncology and Hematology Coding Alert for in-depth analysis of the way you’ll apply the codes after they take effect on Jan. 1, 2023.

Question: What are the current location requirements for telehealth?

Answer: Currently, Medicare beneficiaries can receive telehealth services in their own homes anywhere in the country. Beneficiaries are not limited to qualifying ZIP codes or locations, such as facilities or physician offices.

However, you should still be mindful of where the provider rendering the services is located. Local state restrictions for rendering medical care across state lines, and practice scope limitations along with payer rules and requirements, may limit your ability to bill out-of-state patients for telehealth services. You can begin your research to find out at telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/telehealth-licensing-requirements-and-interstate-compacts/.

Question: What is the current ruling on using HIPAA-compliant technology for telehealth?

Answer: During the PHE, CMS is allowing providers to use “popular non-public facing applications that allow for video chats … without risk of penalty for noncompliance with the HIPAA Rules.” This means providers and patients can currently use such popular audio/video platforms as “Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype” for “all services on the Medicare telehealth list,” according to an FAQ published by CMS (www.cms.gov/ files/document/03092020-covid-19-faqs-508.pdf, page 74).

Question: Can audio-only interaction meet the current PHE Medicare telehealth requirements?

Answer: Yes, but not for all the services on the list. Currently, you can provide “certain counseling behavioral health care and educational services” as audio-only, according to CMS. Also, 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) may be provided as telephone/audio-only services if they are conducted by physicians or other qualified healthcare professionals (QHPs) as the descriptor states.

The physicians and QHPs must also meet and follow current CPT^® guidelines for the services.

Again, you should consult the list for the current status of services that can be provided as audio-only.

Question: What place-of-service code do I need to put on services that are offered via telehealth?

Answer: According to CMS, “for telehealth services furnished during the PHE, CMS is allowing practitioners to use the POS code that they would have otherwise reported had the service been furnished in person.” This means you do not use POS 02 (Telehealth); instead, you would use a code such as POS 11 (Office) if that is where your provider would have normally performed the service.

Question: What modifier do I need to put on services to show they were offered via telehealth?

Answer: To identify services as Medicare telehealth, CMS is requiring you append modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) to the claim.

Question: When will the telehealth waivers end, and will the revised requirements carry over past the PHE?

Answer: The answer to this question is still very much up in the air. Currently, the COVID-19 PHE has been extended until January 11, 2023 (see aspr.hhs.gov/legal/PHE/Pages/ covid19-13Oct2022.aspx). But in a letter to state governors, the Biden administration indicated “when a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination” of the PHE end date. This means, “at present, if the PHE expires on Jan. 11, 2023, the availability of telehealth and the rules applicable during the PHE will extend 151 days after the PHE end date. At this point, that would be June 11, 2023, far into the second quarter of 2023,” notes Leah Fuller, CPC, COC, senior consultant, Pinnacle Enterprise Risk Consulting Services, in Charlotte, North Carolina.

However, complicating matters, on July 27, 2022, the House passed H.R.4040, the Advancing Telehealth Beyond COVID–19 Act of 2021, which would “continue to apply” the telehealth “flexibilities … until Dec. 31, 2024, if the emergency period ends before that date.” Should the act pass the Senate, and should the President then sign it into law, we can expect some of the current waivers to continue until that time.