At innovaTel, we understand that it’s challenging to keep up with regulatory updates and changes. But we also know that keeping up with them is imperative to operational efficiency and patient care.
It’s one of the reasons we appreciate the valuable insight offered by our Chief Compliance Officer, Jordana Bernard. Most recently, CMS released the CY 2022 Physician Fee Schedule (PFS) proposed rule. It’s comprehensive and we’re thrilled that Jordana took time to summarize some if its key points ahead of the deadline for public comment, which is September 13.
In the rule, CMS proposes several provisions to expand coverage and reimbursement of behavioral health services via telehealth and audio-only modalities in the Medicare program. The rule also addresses policy changes for other digital health services.
Key proposals from the rule include:
- Reimbursement for mental health services provided via telehealth without geographic restrictions, including care into the home when the patient receives an in-person service within six months prior to providing an initial telehealth mental health service, and at least once every six months thereafter.
- Reimbursement for mental health services provided to established patients via audio-only telephone when the patient is at home after the public health emergency (PHE).
- Reimbursement for rural health clinics and federally qualified health centers for mental health services via telehealth, including via audio-only services under certain circumstances after the PHE.
- Opioid Treatment Programs (OTPs) may furnish therapy and counseling services using audio-only telephone modalities after the PHE.
- Extends timeframe for coverage and reimbursement of telehealth services added to the Medicare telehealth list on a category 3 basis until the end of CY 2023.
- Reimbursement for extended virtual check-in via video or audio-only telephone to an established patient (CPT code G2252).
A detailed summary of the proposed telehealth changes in the 2022 PFS is provided below:
1. Medicare Telehealth and Other Communications Technology Services
- Medicare Telehealth Services List
- No new telehealth services/billing codes were added to the list for 2022.
- Revises timeframe for Category 3 codes to stay on telehealth list
- Proposes to retain all temporary category 3 services added to the Medicare telehealth services list until the end of CY 2023 versus end of the year in which the PHE expires.
- CMS is seeking comments on which other services slated to expire at the end of the PHE should be added as a category 3.
- Implementation of Telemental Health (TMH) Provisions Per Section 123 in Consolidated Appropriations Act (CCA)
- The CCA passed in December 2020 removed the rural geographic restriction and added the patient’s home as an eligible originating site for TMH visits.
- Requires prior in-person service within six months prior to telehealth encounter; in-person requirement does not apply to substance use disorder treatment services and TMH services that would be eligible outside of what was required by the CAA such as services provided to eligible originating sites in rural areas.
- Seeking comment on whether the in-person visit could be furnished by the same specialty/subspecialty, same group.
- Proposes subsequent in-person visit within 6 months before each telehealth visit.
- Effective after PHE.
- Payment for Audio-only Services
- Proposes to revise regulatory definition of “interactive telecommunications system” (beyond audio-video) to permit use of audio-only communications when used for TMH services if:
- Service is furnished to an established patient.
- Patient receives service at home.
- Provider has capacity to use audio-video for the encounter but the patient lacks capacity for audio-video service or prefers audio-only.
- Patient received an in-person service within six months of the telehealth visit.
- Seeking comment if other higher-level services such as level 4 or 5 E/M visit codes, when furnished alongside add-on codes for psychotherapy, or codes that describe psychotherapy with crisis, could be provided via audio-only telephone under circumstances outlined above
- Effective after PHE.
- New Originating Site Added
- Adds rural emergency hospital as eligible originating site for telehealth services.
- Effective CY 2023.
2. Other Digital Health / Non-Face-to-Face Services Involving Communications Technology
- Seeking comments on making PHE direct supervision requirement via audio-video telehealth permanent policy; revises the definition of “direct supervision” at § 410.32(b)(3)(ii) to include immediate availability through the virtual presence of the supervising physician or practitioner using real-time, interactive audio-video communications technology without limitation after the PHE.
- Proposes to permanently adopt CPT code G2252, virtual check-in service for 11-20 minutes by telephone or video, to an established patient by a physician or QHP who can report an E/M service to determine if an in-person visit is needed; effective after PHE.
3. Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
- Proposes to revise the regulatory definition of an RHC or FQHC mental health visit to include TMH services when furnished through interactive, real-time communications, including audio-only, when the patient is not capable of, or does not consent to the use of devices that permit a two-way, audio-video interaction.
- This is a change to the definition of a mental health visit only; after PHE, RHCs and FQHCs not allowed as “distant site provider” for telehealth services; this would require a legislative change.
- For billing audio-video visits, use HCPCs code G0071 with the 95 modifier; proposes new modifier for audio-only visits.
- Rate paid will be the usual prospective payment system (PPS) rate or all-inclusive rate (AIR).
- Seeking comment on six-month in-person requirement.
4. Medicare Coverage for Opioid Use Disorder (OUD) Treatment Services Furnished by Opioid Treatment Programs (OTPs)
- Proposes to allow OTPs to continue to furnish the therapy and counseling portions of the weekly bundles as well as any additional counseling or therapy that is billed using the add-on code using audio-only telephone in cases where the patient lacks the capacity for audio-video communication, provided all other applicable requirements are met.
- Effective after PHE.
- Use HCPCS code G2080 (add-on code.)
5. Remote Therapeutic Monitoring (RTM)
- New set of 5 billing codes for remote monitoring
- CPT code 989X1: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response), initial set-up and patient education on use of equipment.
- CPT code 989X2: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response), device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days.
- CPT code 989X3: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response), device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days.
- CPT code 989X4: Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes.
- CPT code 989X5: Remote therapeutic monitoring treatment management services, physician/other qualified healthcare professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month, each additional 20 minutes (List separately in addition to code for primary procedure).
- Similar to remote physiologic monitoring (RPM) but different requirements for type of data being collected, how the data is collected, and which clinicians are eligible to bill.
To stay up to date on regulatory changes, sign up for our monthly updates by filling out the form below.