Medicare Telehealth Changes for 2023/2024
Table of Contents
- Major Medicare Telehealth Flexibilities Not Affected by the End of the PHE
- Reporting Home Address
- Expiration of PHE Flexibilities for Direct Supervision Requirements
Major Medicare Telehealth Flexibilities Not Affected by the End of the PHE
These flexibilities will remain in place through December 2024 due to the bipartisan CAA, 2023:
- Medicare beneficiaries can access telehealth services in any geographic area in the U.S., rather than only those in rural areas.
- Medicare beneficiaries can stay in their homes for telehealth visits that Medicare pays for rather than traveling to a health care facility.
- Certain telehealth visits can be delivered audio-only. Check CMS' List of Telehealth Services for those codes.
- Medicare payment for the telephone evaluation and management visits (CPT codes 99441-99443) is equivalent to the Medicare payment for office/outpatient visits with established patients effective 3/1/2020. After the PHE ends, the CAA, 2023 provides for an extension for this flexibility through 12/31/2024.
Reporting Home Address
During the PHE, CMS allowed practitioners to render telehealth services from their home without reporting their home address on their Medicare enrollment while continuing to bill from their currently enrolled location. This waiver will continue through 12/31/2024.
The removal of frequency limitations on certain Medicare telehealth services ended 5/11/2023:
During the PHE, CMS removed frequency restrictions for the following listed codes furnished via Medicare telehealth. All applicable rules for furnishing these services, unless otherwise specified, will once again take effect:
- A subsequent inpatient visit could be furnished via Medicare telehealth, without the limitation that the telehealth visit is once every three days (CPT codes 99231-99233).
- A subsequent skilled nursing facility visit could be furnished via Medicare telehealth, without the limitation that the telehealth visit is once every 14 days (CPT codes 99307- 99310).
- Critical care consult codes could be furnished to a Medicare beneficiary by telehealth beyond the once per day limitation (HCPCS codes G0508-G0509).
Due to a number of inquiries from interested parties, CMS is exercising enforcement discretion and will not consider these frequency limitations through 12/31/2024.
- CMS will consider their policy further through the rulemaking process.
Expiration of PHE Flexibilities for Direct Supervision Requirements
Direct supervision through virtual presence will continue through at least the end of CY 2023.
For CY 2024, CMS is finalizing that they will continue to define direct supervision to permit the presence and immediate availability of the supervising practitioner through real-time audio and video interaction telecommunications through 12/31/2024.
Teaching Physicians
Originally, CMS indicated that effective 5/12/2023, only teaching physicians in residency training sites located outside of a MSA may meet the presence for the key portion requirement through audio/video real-time communications technology.
CMS clarified this practice can continue for all teaching physician services through 12/31/2023. This means that MSA as well as non-MSA teaching physicians may continue to same practice to meet the requirement of being physically present with the resident during the key portions of the service.
CMS has stated in the CY 2024 final rule they will continue to allow teaching physicians to use audio/video real-time communications technology to be present when the resident furnishes Medicare telehealth services in all residency training locations through the end of CY 2024. This virtual presence will meet the requirement that the teaching physician be present for the key portion of the service.
Remote Evaluations, Virtual Check-Ins and E-Visits
Medicare pays for e-visits, which are brief communication services with practitioners, professionals, clinicians, and providers via a number of communication technology modalities, including synchronous discussion over a telephone or exchange of information through video or image. During the PHE, clinicians can provide remote evaluation of patient video/images and virtual check-in services (HCPCS codes G2010 and G2012 for physicians and G2251 and G2252 are for nonphysician practitioners) to both new and established patients. After the end of the PHE, these services may only be provided to established patients.
Mental Health Disorders
Effective immediately on and after the official end of the PHE (5/11/2023), mental health disorders may continue to be offered as telehealth services.
Service for the purpose of diagnosis, evaluation and treatment of mental health disorders will no longer be restricted to beneficiaries residing in rural areas.
Originating sites expanded to include:
- Beneficiary home
- Temporary lodging (hotels, homeless shelters, nursing homes)
- Originating site facility fee does not apply
Audio only communication is permitted for established patients in their home if:
- They don’t have the technical capacity
- They don’t have the availability of real-time audio and visual interactive telecommunication
- They don’t consent to a virtual call
Medical record should support the reason for using audio-only communication.
Continue to report FQ Modifier (A telehealth service was furnished using real-time audio-only communication technology).
Revised 11/16/2023