Tech & Innovation in Healthcare

Prepare for post-COVID visits with finalized POS codes.

On Nov. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2023 Medicare Physician Fee Schedule (MPFS), and includes positive news for providers who use telehealth services with their patients.

Dive into the MPFS final rule to learn how telehealth services are affected in 2023.

Aligning Telehealth Services With the CAA, 2022

Healthcare providers and patients have adopted telehealth use during the COVID-19 public health emergency (PHE), and CMS followed through on its proposals to apply the telehealth services requirements put forth in the Consolidated Appropriations Act, 2022 (CAA, 2022).

“The Biden-Harris Administration has committed to taking into account this national experience with telehealth during the PHE while ensuring a smooth transition for Medicare beneficiaries and health care providers once the PHE ends,” wrote Dr. Jackie Ward, assistant director for community connected health, White House Office of Science and Technology Policy (OSTP), in a blog post.

The finalized policies include allowing:

• Telehealth services to be furnished in any geographic area and in any originating site setting, which includes the Medicare beneficiary’s home;
• Certain services to be furnished via audio-only telecommunications systems (telephone calls);
• Telehealth services to be furnished by physical therapists (PTs), occupational therapists (OTs), speech-language pathologists (SLPs), and audiologists; and
• Services included on the Medicare Telehealth Services List on a temporary basis will remain on the list throughout the public health emergency (PHE) and for at least 151 days following the declared end of the PHE.

Each year, CMS may add services to the Medicare Telehealth Services List on a Category 1, 2, or 3 basis. Categories 1 and 2 represent permanent additions to the Telehealth Services List, while Category 3 codes are added on a temporary basis. For CY 2023, CMS finalized adding 54 additional services to the Telehealth Services List on a Category 3 basis. These codes cover a wide range of care, including emotional/behavior assessment, audiology, and developmental screening.

Understand the Mental Health Visit Requirement Delay

CMS is also delaying the in-person requirement for mental health visits furnished by rural health centers (RHCs) and federally qualified health centers (FQHCs), so practitioners can continue to provide mental health services via telehealth. This delay complies with the CAA, 2022, and the in-person requirement delay is scheduled to expire 152 days after the end of the PHE.

“Access to services promoting behavioral health, wellness, and whole-person care is key to helping people achieve the best health possible,” says CMS Administrator Chiquita Brooks- LaSure in a release. “The Physician Fee Schedule final rule ensures that the people we serve will experience coordinated care and that they have access to prevention and treatment services for substance use, mental health services, crisis intervention, and pain care.”

Learn How Providers Can Bill for Telehealth Services

In 2023, CMS finalized how physicians and practitioners bill for telehealth services. Healthcare professionals will append the appropriate telehealth service code with modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) and a corresponding place of service (POS) indicator. Under the final rule, CMS finalized continuing to let providers bill for POS based on where the service would normally have been performed.

However, on the 152nd day following the PHE’s conclusion, practitioners will need to use either of the following POS code options:

• POS 02 (Telehealth provided other than in patient’s home)
• POS 10 (Telehealth provided in patient’s home)

Effective Jan. 1, 2023, coders will use CPT^® modifier 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system) if a telehealth service was furnished via a telephone call. Providers in RHCs, FQHCs, and opioid treatment programs (OTPs) are also required to use modifier 93 to bill audio-only telehealth mental health services. At the same time, RHC, FQHC, and OTP providers are required to append Medicare modifier FQ (The service was furnished using audio-only communication technology) for audio-only telehealth services that are allowed to be furnished in those settings.

CMS also stated in the final rule that “Providers have the option to use the FQ or the 93 modifiers or both where appropriate and true, since they are identical in meaning.” You should review your individual payer policies to double-check if the payer prefers one modifier or both.

“This year’s rule is extensive with an overarching focus on the Biden-Harris Administration’s priority to create a more equitable health care system that results in better accessibility, quality, affordability, and innovation,” Dr. Ward wrote.