By: Center for Connected Health Policy

Last month the Centers for Medicare and Medicaid Services (CMS) released an updated Telehealth Services Medicare Learning Network (MLN) Fact Sheet reflecting new information for 2024. Most of the guidance remains unchanged and updates largely focus around incorporating already adopted policies from the Consolidated Appropriations Act, 2023 (CAA 2023) and CY 2024 Physician Fee Schedule (PFS) Final Rule. However, the document serves to assist providers struggling to keep up with shifting billing rules and offers the potential to clarify outstanding reimbursement issues as well as provide a reminder of current Medicare telehealth policies.

The CMS Fact Sheet also describes general telehealth coverage rules and provides background on pre-COVID-19 Public Health Emergency (PHE) policy in addition to extended PHE flexibilities. For instance, it describes permanent laws that limit eligible originating sites and distant site providers while clarifying that through December 31, 2024, such restrictions are waived. Currently, due to extended PHE flexibilities, patients can receive services wherever they are located and all providers who are eligible to bill Medicare can provide distant site telehealth. In addition, while Medicare typically only covers live video telehealth, there are ongoing allowances for audio-only in some instances.

Where Medicare billing for telehealth services gets most complicated is in regard to specific payment rules and coding requirements. Reimbursement questions are what CCHP receives frequently from providers, as billing policies vary depending on the type of provider and service provided, making application of the rules different in various circumstances. For instance, the CMS Fact Sheet includes updated information related to telehealth modifiers and Place of Service (POS) codes that commonly are the subject of the billing questions received by CCHP. Some of the updated information most helpful to highlight relate to different guidance for hospitals and non-hospital-based providers. The use of modifier 95 is being extended in the updated guidance but only when the clinician is in the hospital and the patient is in the home, as well as for outpatient therapy services provided via telehealth by qualified physical therapists (PTs), occupational therapists (OTs), or speech language pathologists (SLPs) through December 31, 2024. As noted in the Fact Sheet, hospitals and other providers of PT, OT, SLP, diabetes self-management training (DSMT) and medical nutrition therapy (MNT) services that remain on the Medicare telehealth services list may continue to bill for these services when provided remotely in the same way they’ve been during the PHE, except that:

• For outpatient hospitals, patients’ homes no longer need to be registered as provider-based entities to allow for hospitals to bill for these services
• The 95 modifier is required on claims from all providers, except for Critical Access Hospitals (CAHs) electing Method II, as soon as hospitals needing to do so can update their systems

For non-hospital-based providers, the updated Fact Sheet information states providers should also continue billing telehealth claims with the POS indicator used for an in-person visit and, starting January 1, 2024, use:

• POS 02-Telehealth to indicate you provided the billed service as a professional telehealth service when the originating site is other than the patient’s home
• POS 10-Telehealth for services when the patient is in their home

One additional issue connected to this new POS guidance has become apparent. As recently reported by Noridian, a Medicare Administrative Contractor (MAC), despite CMS previously stating that POS 10 would receive the higher non-facility rate when billed (see CMS 2024 PFS, CMS 2024 PFS MLN, and CCHP’s 2024 PFS Fact Sheet for more information), it appears CMS has instead been reimbursing at the lower facility rate so far this year. CCHP has received several inquiries on the subject and has reached out to CMS for clarification, with no new guidance provided as of yet. As also noted in the Noridian article, it is understood that CMS is aware of the issue and currently looking further into it. CCHP will provide more updates and additional clarifications on Medicare telehealth billing issues once new information is received.

Other updates in the latest version of the Fact Sheet include:

• New codes added to the Medicare telehealth services list
  • CPT codes 0591T – 0593T for health and well-being coaching services, added on a temporary basis
  • HCPCS code G0136 for Social Determinants of Health Risk Assessment, added on a permanent basis
• Other CAA 2023/CY 2024 PFS additions, such as:
  • Continuing payment for telehealth services rural health clinics (RHCs) and federally qualified health centers (FQHCs) provided using the methodology established for those telehealth services during the PHE
  • Delaying mental health telehealth and RHC/FQHC in-person requirements
  • Allowing teaching physicians to use audio or video real-time communications technology in all residency training locations through the end of CY 2024
  • Removing frequency limitations in 2024 for subsequent inpatient visits, subsequent nursing facility visits, critical care consultation
• CY 2024 Originating site facility fee amount – HCPCS Code Q3014 describes the Medicare telehealth originating sites facility fee. Bill MAC for the separately billable Part B originating site facility fee. The payment amount for HCPCS code Q3014 (Telehealth originating site facility fee) is 80% of the lesser of the actual charge ($29.96 for CY 2024 services)

Other items covered in the Fact Sheet include:

• Through December 31, 2024, you may use telehealth to conduct hospice care eligibility recertification
• CMS has extended the Acute Hospital Care at Home Program, which heavily relies on telehealth for hospitals to provide inpatient services, including routine services, outside the hospital
• Telehealth Home Health information – G-Codes indicating use of telehealth technology in providing home health services
• General billing rules regarding billing covered telehealth to Medicare Administrative Contractors (MACs)
• Consent for care management and virtual communication services requirements

For additional Medicare telehealth billing information, please view the following resources:

• Review Provider Billing Medicare FFS Telehealth for billing and coding information for Medicare Fee-for Service claims
• HHS Telehealth policy changes after the COVID-19 public health emergency
• HHS Telehealth Information for Patients and Providers

As always, federal telehealth information can be found on CCHP’s online policy finder, in the federal section. As we move forward, CCHP will continue to keep readers updated on the latest in Medicare telehealth billing.

SOURCE: (Center for Connected Health Policy, personal communication, March 5, 2024)