Recently, the Centers for Medicare & Medicaid Services (CMS) published its Final Rule implementing changes to the Medicare Physician Fee Schedule for CY 2023. In addition to recent clinical laboratory updates, the Final Rule also includes certain changes regarding billing and reimbursement for telehealth services and gives providers guidance on transitioning away from the flexibilities that arose out of the COVID-19 public health emergency (PHE).
In determining whether new telehealth services may be included on the list of Medicare-covered codes, CMS assigns each potential addition to one of three defined categories. Category 1 services are those similar to professional consultation, office visits, and office psychiatry services already on the approved telehealth list. Category 2 services, which are not similar to services already on the approved telehealth list, are assessed by CMS to determine whether there is evidence of clinical benefit to patients when the service is provided via telehealth. Category 3 encompasses services added on a temporary basis during the PHE that would facilitate continued access to medically necessary services during the pandemic, but for which there is insufficient evidence to evaluate the services for permanent addition under Category 1 or Category 2 criteria.
In the Final Rule, CMS made the following changes with respect to the approved Medicare Telehealth Services List:
- On a Category 1 basis, added certain prolonged observation codes and new chronic pain management services codes.
- On a Category 3 basis, approved a number of services including certain therapy, neurotransmitter pulse generator, emotional/behavior assessment, and psychology or neuropsychology testing and evaluation codes.
- CMS declined to approve, on a Category 3 basis, certain GI tract imaging, continuous glucose monitoring, and certain neurotransmitter pulse generator/transmitter services, as well as declined to add telephone E/M visit codes.
Additionally, through program instruction or other guidance, CMS will implement the Consolidated Appropriations Act of 2022 provisions that extended reimbursement for certain telehealth services for 151 days following the end of the PHE. In the Final Rule, CMS points out that on the 152nd day following the end of the PHE, Medicare telehealth services will again be subject to the restrictions set forth in the Social Security Act, including the geographic and originating site limitations placed on telehealth reimbursement. Providers should remain conscious of the status of the PHE and plan accordingly to comply with the more stringent standards following the end of the PHE.
For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding new developments in healthcare law and regulation. If you or your healthcare entity has any questions pertaining to Medicare telehealth compliance or healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or wapc@wachler.com.