Final CY 2023 Medicare Physician Fee Schedule Extends Some Telehealth Flexibilities Post-PHE

On November 2, the Centers for Medicare & Medicaid Services (CMS) released its annual final rule updating the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2023, which included various changes related to the provision of telehealth, including implementing telehealth provisions included within the Consolidated Appropriations Act, 2022, and extending coverage through the end of CY 2023 for some telehealth services that have been enabled during the PHE, among others. CMS also finalized changes related to remote therapeutic monitoring services. This newsletter summarizes select telehealth and remote therapeutic monitoring provisions. Implementation of Congressional Telehealth Improvements. In March 2022, President Biden signed the Consolidated Appropriations Act, 2022, an omnibus funding bill that included several telehealth provisions aimed at ensuring a smooth transition after the end of the COVID-19 public health emergency (PHE).¹ The bill extended Medicare coverage for a broad range of telehealth services for 151 days after the end of the PHE that would have otherwise expired at the end of the PHE.

The Centers for Medicare & Medicaid Services (CMS) is implementing several telehealth provisions in the Consolidated Appropriations Act, 2022, by:

• Extending coverage of services temporarily added to the Medicare Telehealth Services list during the PHE for 151 days after the end of the PHE
• Extending the following telehealth policy flexibilities, via program instruction or other sub-regulatory guidance, for 151 days after the end of the PHE:
  • Any site in the United States, including a patient’s home, will be considered an eligible originating site for the delivery of telehealth services.
  • Facility fees will not be paid to newly covered originating sites (e.g., a patient’s home).
  • Eligible telehealth practitioners will continue to include qualified occupational therapists, physical therapists, speech-language therapists and audiologists.
  • Federally qualified health centers (FQHCs) and rural health clinics (RHCs) may serve as originating or distant sites for the delivery of telehealth services.
  • Providers will not be required to meet in-person visit requirements in order to deliver mental health services via video or audio-only visits. This applies to all sites of care, including FQHCs and RHCs (except in the case of hospice patients).
  • Coverage of telehealth services delivered via audio-only format will continue for specific service codes identified by Medicare as being eligible for delivery via audio only.

Proposed Changes to the Medicare Telehealth Services List. CMS is finalizing several changes to the list of telehealth services eligible for Medicare coverage.

• Temporarily Extending Coverage for Some “Category 3” Telehealth Services Through CY 2023. CMS will make several services that are temporarily available via telehealth during PHE available through the end of CY 2023 under the “Category 3” designation. Category 3 services are services with respect to which CMS has determined there is likely clinical benefit when furnished via telehealth but there is not sufficient evidence available to justify permanent coverage. Acknowledging the need to gather more information regarding the utilization, clinical appropriateness and value of these services, CMS has added the following services, among others, to the list of “Category 3” services through the end of CY 2023: emotional/behavioral assessment, psychological, and neuropsychological testing and evaluation services; eye exams with established patients; select neurostimulator pulse generator/transmitter services; wheelchair management training; and psychophysiological therapy.
• Permanently Adding Coverage for Prolonged Services in Various Settings and Chronic Pain Therapy and Management as “Category 1” Services. CMS will permanently cover prolonged services delivered via telehealth by a physician or other qualified health practitioner in inpatient or observation, nursing facility, or home/residence settings as “Category 1” telehealth services. CMS will also permanently cover monthly chronic pain therapy and management.
• Removing Some Services From Medicare Telehealth Services List After the End of the 151-Day Period Following the End of the PHE. CMS will end coverage for some telehealth services that have been temporarily covered via telehealth during the PHE after the end of the 151-day period following the end of the PHE, including neonatal and pediatric critical care initial services, radiation services, eye exams with new patients, some hospital and nursing-facility-level care, and telephone evaluation and management visits.

Remote Therapeutic Monitoring (RTM) Services. CMS finalized Medicare payment for five remote therapeutic monitoring (RTM) codes in the CY 2022 Physician Fee Schedule (PFS) final rule. In the CY 2023 proposed rule, CMS had proposed four new codes to address concerns about access to RTM services and supervisory requirements. Due to confusion around the proposed codes, CMS will not include these codes for CY 2023 and will continue to gather information and experience with regard to coding and payment policies for RTM services.

CMS notes that there was a request from stakeholders to develop a generic device code for RTM (the current codes are limited to monitoring respiratory or musculoskeletal systems) but reiterates its decision to wait on developing a general code and is seeking comments to better understand the costs, data and utilization of expanding to additional systems and conditions. Lastly, CMS is finalizing that for 2023, the CPT code covering cognitive behavioral therapy monitoring device supply (989X6) be contractor priced (i.e., reimbursement rates established by each local Medicare Administrative Contractor).

Proposed Changes to Modifiers. During the COVID-19 PHE, CMS temporarily instructed providers delivering services via telehealth to report those services with a place of service that would have been reported had the service been furnished in person, along with the modifier “95.” This policy allowed CMS to pay for services furnished via Medicare telehealth that would have been furnished in person at the same rate they would have been paid if the services had been furnished in person.

CMS is now finalizing policies for the winding down of this procedure. After the end of the 151-day period following the end of the PHE, providers would indicate the appropriate place of service (POS) on telehealth claims. The POS indicators for telehealth will be POS “02” (redefined as telehealth provided other than patient’s home) and POS “10” (telehealth provided in patient’s home). CMS will now require modifier “93” for telehealth services delivered via audio-only technology.