It seems like we’re almost at the end of the pandemic — but with COVID there have been many twists and turns. While we’re all tired of it (I know I am), the pandemic has at least proven that we’re resourceful and can come up with new ways to get our patients treated.

One example has been telemedicine (TM), which many (but not all) practices embraced during the lockdowns we endured early in the COVID-19 pandemic. The feedback from both patients and caregivers has been positive, and many want it expanded. Payers, including Medicare, largely relaxed their rules since they knew it was good medicine not to just ignore chronic diseases.

A few months ago, as part of passage of the 2022 Final Physician Fee Schedule (MPFS) rule, the Centers for Medicare & Medicaid Services (CMS) took the opportunity to slightly relax their rules for TM, which had historically been fairly restrictive in terms of which codes providers could use and under which circumstances. Medicare’s rules during the pandemic were VERY relaxed; but the new MPFS 2022 rules would be somewhere in-between the old strict rules the pandemic rules.

I’ve often been asked recently “what happens next?” Which rules do we follow if we want to continue to utilize TM?

A pandemic rule recap

Under the Public Health Emergency (PHE) special rules put in place on March 13, 2020, by the Secretary of Health and Human Services (HHS) Alex Azar¹ and continued by Xavier Becerra (HHS Secretary under President Biden), CMS made special waivers (known as Section 1135 Waivers) to make TM use simpler and more available. They also improved payment by allowing for Place of Service (POS) 11 (“Office”) on claims. Medicare contractors and private payers may require other POS for TM after the PHE ends, so be sure and check.

Importantly, since this declaration can only run for up to 90 days, it must be periodically renewed or allowed to expire. It has been renewed every 90 days since being put into place. The most recent renewal was on April 12, 2022.

As I write this, the next expiration date is mid-July 2022, and it may be renewed at least once more (that’s a guess on my part, but it seems pretty likely because CMS has to give states at least 60 days advance notice if they do not plan to renew it).

Extended through 2022

Recently, however, Congress acted at the behest of patients and providers to provide some clarity. Congress acted by passing the Consolidated Appropriations Act, and the President signed into law on March 15, 2022², to extend the special conditions for TM coverage through the end of the 2022 year. If this had not been enacted AND the PHE declaration had expired, you would have received a lesser payment for all common TM services (at facility rates) and there would have been important code use restrictions (e.g., perhaps the loss of the ability to use Eye codes).

Put another way, the current law states that even if the PHE declaration ends, the current “most relaxed” guidance for TM claims now runs through the end of 2022. Those practices using TM for their patients can continue to do it as they have been for Medicare Part B and their payments won’t go down for now.

Private payers do not have to follow Medicare, but they were already ahead of Medicare since they are generally more responsive to their beneficiaries (who pay their costs directly).

Summary

Even if the PHE declaration ends in July 2022, Medicare will keep the relaxed rules related to telemedicine coverage through the end of 2022. Private payers don’t have to follow the same rules, but they were more forward-thinking in terms of TM.

What happens for 2023 is unknown, but it does seem that the demands of patients are being listened to. Furthermore, it seems likely that TM is here to stay and that it will expand, so the rules and payments related to it will follow at some time down the road.

Be on the lookout for changes in 2023, though. CMS’ old rules were very restrictive. Although relaxed a bit, the 2023 rules and payment may not be as forgiving as the current pandemic rules.

As always, “good coding to you.” OP

References

1. Waiver or Modification of Requirements Under Section 1135 of the Social Security Act. March 13, 2020. https://www.phe.gov/emergency/news/healthactions/section1135/Pages/covid19-13March20.aspx . Accessed May 24, 2022.
2. Congress.Gov . HR 2471. Consolidated Appropriations Act, 2022. https://www.congress.gov/bill/117th-congress/house-bill/2471/text?r=31&s=1 . Accessed May 24, 2022.

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