Pathology/Lab Coding Alert

Legislation gives limited waiver extension.

With many providers angling to make COVID-19 telehealth waivers permanent, recent legislation offers a partial “yes,” by extending the waivers beyond the end of the public health emergency (PHE).

Details: On March 15, President Biden signed the long-awaited and much debated Consolidated Appropriations Act (CAA) of 2022. This omnibus bill “consolidates” an amalgam of policies across the federal government, putting them into one piece of massive legislation, and “appropriates” funding for various programs and initiatives, including $108.3 billion earmarked for the Department of Health and Human Services (HHS) for fiscal year (FY) 2022. Sandwiched in the bill are a few Medicare-centered updates on telehealth expansion.

Recap and Regroup

In March 2020, the Centers for Medicare & Medicaid Services (CMS) issued a plethora of 1135 waivers and coverage flexibilities for telehealth services to address COVID-19, lifting previous location and technology restrictions. These changes offered Medicare coverage to beneficiaries for specific telehealth services, and the omnibus bill provides an update.

The legislation “extend[s] the current telehealth accommodations for 151 days after the end of the federal public health emergency, which is currently set to expire in [July],” explains partner attorney Eric Fader with law firm Rivkin Radler LLP in online legal analysis.

Caveat: The omnibus bill doesn’t make the Medicare telehealth expansion permanent, as many had hoped, but merely extends it for about five months past the final COVID-19 PHE’s end. Plus, Congress asks the Medicare Payment Advisory Commission (MedPAC) in the legislation to compile a report on the telehealth expansion in reference to the PHE — with a June 15, 2023, due date.

Industry Organization Weighs In

Though the feds have only temporarily removed pre-COVID restrictions on telehealth services, the American Medical Association (AMA) is hopeful that the provisions outlined in the Omnibus bill are a step in the right direction.

“Congress has taken a crucial step in starting a revolution in patient access. The AMA aims to continue being a partner in moving it forward,” says AMA President Gerald E. Harmon, MD, in a release on the legislation. “The dramatic increase in adoption of telehealth that occurred in 2020 has allowed medical care that combines in-person and virtual services to become the new standard of care. This new legislation guarantees that patients with Medicare will continue to benefit from this important innovation in health care delivery.”

Remote Pathology Sign Out Waiver Is Different

Although pathologists are less likely than other specialties to use telemedicine for interacting with patients, they’re among the highest telemedicine users for interacting with other healthcare professionals according to an AMA 2019 telemedicine benchmark study (www.ama-assn.org/practice-management/digital/which-medical-specialties-use-telemedicine-most). The study broadly defines telemedicine beyond Medicare and CPT^® definitions to include data storing and forwarding, which pathologists use extensively.

Importance: Similar to telehealth expansion during the PHE, CMS used an enforcement announcement on March 26, 2020, (www.cms.gov/files/document/qso-20-21-clia.pdf-0) to pave the way for pathologists to review slides and test results and sign out remotely during the PHE. The action waives the requirement for remote locations to have separate CLIA licenses.

The waiver allows remote sign out with digital pathology or glass slide pathology cases, as well as clinical data such as fluorescence in situ hybridization (FISH), molecular tests, flow cytometry, etc. The waiver applies to pathologists and other personnel, such as cytogeneticists and cytotechnologists, allowing them to review lab data at a temporary location by reporting the associated lab’s CLIA number and not getting a separate offsite Clinical Laboratory Improvement Amendments (CLIA) number.

These changes are effective through the PHE, and the recent omnibus bill did not address extending these waivers.

Resources: Read the text of the CAA, 2022, at www.congress.gov/bill/117th-congress/house-bill/2471/text.