Tech & Innovation in Healthcare

Could POS-10 be receiving new reimbursement? Find out.

On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS) proposed rule. With the COVID-19 public health emergency (PHE) in the rearview mirror, many healthcare providers have been itching to see how CMS is planning to handle telehealth going forward — and the agency did not disappoint.

Tech & Innovation in Healthcare dove deep into the proposed rule to uncover the possible telehealth plans for 2024.

Extending and Revising COVID-Era Telehealth Flexibilities

Enacted on Dec. 29, 2022, the Consolidated Appropriations Act, 2023 (CAA, 2023) extended certain Medicare telehealth flexibilities through the end of 2024. CMS is proposing to implement the CAA, 2023 rules and extend telehealth flexibilities through Dec. 31, 2024.

The telehealth flexibilities in the CAA, 2023 and the MPFS proposed rule include:

• Removing originating site restrictions: Providers may bill for services delivered to patients during a telehealth visit when the patients are located anywhere in the U.S.
• Approved providers: Audiologists, speech-language pathologists, physical therapists, and occupational therapists may provide and bill for telehealth services.
• Facilities: Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) may provide and bill for telehealth services supplied to patients in their homes or other locations within the U.S.
• In-person visit requirement delay: FQHCs, RHCs, mental health practitioners, and physicians can initiate mental health telehealth services without needing a prior in-person visit.
• Covered services: CMS proposes providing payment for telehealth services that are included on the Medicare Telehealth Services List as of March 15, 2020, including audio-only services.

Marriage and family therapists (MFTs) and mental health counselors (MHCs) were added to the list of eligible practitioners in the CAA, 2023, and CMS is proposing permanently adding these providers on Jan. 1, 2024.

“We intend to implement the provisions discussed above, as enacted by the CAA, 2023,” the agency wrote in the proposed rule.

Learn Which Telehealth Statuses Could Be Changing

CMS received several requests to add specific CPT^® codes to the Telehealth Services list on a permanent basis. Examples of the requested codes include, but are not limited to, the following:

• 93797 (Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session))
• 94625 (Physician or other qualified health care professional services for outpatient pulmonary rehabilitation; without continuous oximetry monitoring (per session))
• 90901 (Biofeedback training by any modality)
• 99221 (Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.)
• 0591T (Health and well-being coaching face-to-face; individual, initial assessment)

However, CMS claims that none of the requested codes meet the agency’s “Category 1 or Category 2 criteria for permanent addition to the Medicare Telehealth Services List,” in the proposed rule.

“Though CMS did not propose to permanently add any of these codes to the Telehealth List, they did propose to keep them there through Dec. 31, 2024,” wrote Kaitlyn O’Connor, Esq, partner and Aizaz Chaudhary, Esq, counsel, of Nixon-Gwilt Law in Virginia, in online analysis.

Requesting additions to the Medicare Telehealth Services List could get easier in 2024, if the proposals are finalized. Currently, there are three categories of telehealth services — Categories 1 and 2 are permanent, while Category 3 telehealth services are temporary. CMS is proposing revamping the telehealth services list structure to “permanent” and “provisional” designations.

“To provide a transition period for this new process, CMS proposes to move all codes currently in Categories 1 and 2 to the ‘permanent’ list. Any codes added on a ‘temporary Category 2’ or a Category 3 basis would be placed on the ‘provisional’ list,” McDermott+Consulting, an affiliate of law firm McDermott Will & Emery, noted in online analysis.

Simplify Requests for Additions to the Telehealth Services List

If the proposed changes are finalized, CMS would need to complete a five-step process to add services to the Telehealth Services List in 2024:

1. Payable: CMS must determine if the requested service is separately payable under the MPFS.

2. Social Security Act: CMS must determine if the requested service meets the provisions of section 1834(m) of the Social Security Act, which requires the in-person, face-to-face portions of the service to be furnished via an interactive telecommunications system.

3. Equipment: CMS must determine if the HCPCS or CPT^® code elements can be supplied with an interactive telecommunications system.

5. Benefit: CMS must consider whether the requested service will provide the same clinical benefit as if the service was furnished in person.

If CMS determines positive results from step four, then the service will be added to the Telehealth Services List on a permanent basis. However, if CMS finds evidence of step five, then the service may be added on a provisional basis.

“CMS would monitor provisional services and could, at its discretion based on evolving clinical evidence, either upgrade a service from provisional to permanent or remove the service from the list in the future,” Nixon-Gwilt attorneys explained.

POS-10 Paid at National Non-Facility Rate