2024 Medicare Physician Fee Schedule Final Rule Expands Telehealth Policy for COVID-19 to Include Bonus Extension | JD Supra

Key findings from the Final Rule are explained in more detail below.

Entry of home addresses of remote doctors

The CI 2024 proposed rule did not address enrollment and claim-related issues for telepractitioners, although providers and practitioners have increasingly expressed concerns in this area. In response to this feedback, the Final Rule extends through the end of CI 2024 the public health emergency (PHE) COVID-19 flexibility that allows telehealth practitioners to provide telehealth services from their homes while continuing to bill from their current enrolled location without registering your home. address.

Privacy issues associated with reporting home addresses, as well as the administrative burden of changing billing practices, adding home addresses to the Medicare enrollment file, and coordinating with appropriate Medicare administrative contractors (MACs) were among the concerns raised by the Centers for Medicare & Medicaid Services (CMS). Under long-standing cross-jurisdictional redeployment guidance, practices would be required to enroll in MACs of remote practitioners who provide services from another MAC jurisdiction because they have moved or who have been recruited remotely to provide services in short supply. CMS indicated that the agency plans to consider how to address the challenges associated with enrollment and claims for services provided by remote practitioners in the future once the flexibility ends.

Payment changes for telehealth services

As proposed, the COVID-19 PHE flexibility that allows physicians and practitioners who have billed Medicare telehealth services to report to a point of service (POS) that would report that the service was provided in-person should end at the end of CI 2023 .Starting at the beginning of CI 2024:

• Telehealth services provided to patients who are not at home (including office patients) should be reported with POS 02 and will be billed at the facility rate beginning in early CI 2024. When the clinician is in the hospital and the patient is at home, the billing physician should use hospital POS code along with modifier 95.
• All telehealth services provided to patients in their homes should be reported with POS 10 and will be paid at the higher non-facility rate.

Without further legislative changes, when the Consolidated Appropriations Act (CAA) of 2023 completes the expansion of flexibility related to originating sites, a patient’s home will not be a Medicare-eligible originating site for services other than mental health and other very limited exceptions. Therefore, most telehealth claims, other than mental health telehealth, would be paid at the facility rate without further changes. CMS believes this is appropriate based on the belief that the facility costs (clinical staff, supplies, and equipment) associated with providing the service will generally be borne by the originating location where the patient is located, rather than by the remote physician.

Billing for telehealth outpatient therapy, diabetes self-management training (DSMT), and medical nutrition therapy (MNT)

Hospitals will be allowed to bill for outpatient physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), DSMT, and MNT services provided by therapists and institutional staff to patients in their homes by the end of 2024. In this context, homes beneficiaries do not need to be registered as provider-based hospital departments, but institutional providers should apply modifier 95 on the claim line when billing for these services.

Facilitating the virtual presence of the teaching physician

CMS has finalized its proposal to continue to allow virtual presence in all teaching settings in clinical cases where the service is provided virtually via telehealth (eg, a three-way telehealth visit with multisite parties). This virtual presence policy continues to require real-time observation (not just availability) by the teaching physician and excludes audio-only technology.

CMS used implementation discretion to allow teaching physicians at all residencies to be present via real-time audio/video communication technology for MPFS billing purposes for services they provide to residents through the end of the 2024 rulemaking process.

Removal of certain telehealth frequency limits for follow-up hospital visits, follow-up visits to healthcare facilities and intensive care consultations

CMS finalized its proposal for CI 2024 to continue removing frequency limits for follow-up hospital visits, follow-up health facility visits, and critical care consultations. CMS policy applies to the following codes:

• Follow-up hospital visit CPT codes 99231, 99232, 99233
• Follow-up visits to health facilities CPT codes 99307, 99308, 99309, 99310
• Intensive care consultation services – HCPC codes: G0508, G0509

CMS explained that the continued suspension of frequency limits on an interim basis for CI 2024 will allow more time to assess patient safety while preserving access to care in a manner that does not disrupt practice patterns established during PHE. CMS will continue to evaluate the data and responses it received to the proposed rule as it determines the most appropriate way to support patient safety while promoting access to care.

Guidelines for RPM and RTM payments

CMS has finalized proposals for Remote Patient Monitoring (RPM) and Remote Therapy Monitoring (RTM) by adopting the following policies:

• Physicians may separately deliver and be paid for RPM or RTM services provided to a beneficiary who received a procedure or surgery that is covered by payment for the global period.
• RPM, RTM, Community Health Integration (CHI), and Major Illness Navigation (PIN) services will be included in HCPCS code G0511 for general care management when these services are provided by RHCs and FKHCs.

Billing for RPM and RTM services

By way of background, in the MPFS final rule for CI 2020, CMS affirmed that a family of RPM codes (CPT codes 99453, 99454, 99457, and 99458) describe chronic care RPM services that include the collection, analysis, and interpretation of digitally collected physiological data and then a treatment plan and managing the patient according to the treatment plan. In the MPFS Final Rule for CI 2024, CMS reminded stakeholders that the code family for RTM services includes CPT codes 98975, 98976, 98977, 98978, 98980, and 98981 that involve monitoring adherence to a program or therapy through scheduled imaging, or an alert, or interactive communication with the patient or caregiver. In the previous rulemaking, CMS confirmed that telemonitoring codes are designated as care management services and that the rules for general monitoring apply. In the CI 2024 Final Rule, CMS discussed its previous policy as stated in the CI 2023 PFS Final Rule, where code sets 98975, 98976, 98977, and 98978 require data collection of no less than 16 days in a 30-day period.

RPM services can only be provided to established patients:

The final rule confirms that RPM services can only be provided to established patients, meaning that an initial visit is required for patients who have not been seen by a physician in the past year. As a reminder and as explained in the proposed rule, CMS confirmed that patients who received initial RPM services during PHE are established patients.

Data Collection Requirements/Applicable Code Sets:

In the final rule, CMS clarified that the following codes require the collection of at least 16 days of data in a 30-day period, collected on at least one medical device as defined in section 201(h) of the FFDCA: 98976, 98977, and 98978. CMS further clarified that the 16-day data collection requirement does not apply to CPT codes 99457, 99458, 98980, and 98981. CMS inadvertently included the former codes in the discussion of the proposed rule. Data collection requirements do not apply to codes 99457, 99458, 98980, and 98981 because they are treatment management codes that count time spent in a calendar month.

As originally stated in the PFS CI 2021 Final Rule, CMS reiterated that even when multiple medical devices are provided to a patient, services associated with all medical devices may be billed only once per patient in a 30-day period and only when at least Data are collected for 16 days.

Payment for RPM or RTM in combination with other services:

In the MPFS Final Rule for CI 2024, CMS clarified its policy that when RPM and RTM are provided along with other services, practitioners may bill for either RPM or RTM services, but not both. RPM or RTM services may be billed concurrently with certain care management services for the same patient as long as the time or effort is not counted twice. Care management services include chronic care management (CCM)/transitional care management (TCM)/behavioral health integration (BHI), primary care management (PCM) and continuous passive movement (CPM). CMS confirmed that according to the 2023 Current Procedural Terminology (CPT) Code:

• CPT code 98980 (RTM treatment management) cannot be reported together with CPT codes 99457/99458 (RPM treatment management).

CMS remains focused on enabling practitioners to select appropriate care management services while reducing the significant problems of potential fraud, waste, and abuse associated with overbilling for these services.

Appropriate calculation of RPM or RTM services:

In the final rule, CMS confirmed that practitioners may separately deliver and be paid for RPM or RTM services to a beneficiary who received a procedure or surgery that is covered by global period payment. Payment for RTM or RPM services would be separate from global payment. In other words, the prohibition against providing RPM or RTM services during the global period applies only to billing practitioners who have received payment for the global service.

Specifically, CMS has concluded that providing RTM or RPM services during the global period is permissible if the practitioner does not receive global payment for the service because it did not provide a global procedure.

RPM and RTM services provided by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FKHCs):

Finally, CMS finalized its policy to include RPM, RTM, Community Health Integration (CHI), and Major Illness Navigation (PIN) services in HCPCS general care management code G0511 when these services are provided by RHCs and FKHCs.

Conclusion

The CI 2024 final rule finalizes a number of important extensions to telehealth flexibility established during PHE and clarifies payment policies related to telehealth and other telehealth services. The final rule reinforces CMS’ continued emphasis on promoting patient access to care while continuing to evaluate post-PHE practice and utilization patterns to identify whether more permanent changes to these policies are appropriate.