Medicare’s coverage for telehealth has adapted to meet the needs of patients and providers during Covid-19 and even now, continues to evolve! But what changes were made and are they here to stay now that the pandemic is reaching its end? Here’s all the information you need to know about telehealth regulations, rules, and more as an outpatient therapist.
How Has the Public Health Emergency Affected Medicare Telehealth Services?
Telehealth adoption was low before the COVID-19 public health emergency (PHE) and primarily targeted rural areas with poor access to health services. However, the stay-in-place orders as a result of the pandemic necessitated remote health care for everyone – and fast.
This idea was rapidly adopted by the Centers for Medicare and Medicaid Services (CMS), which was quick to improve access and encourage the use of telehealth. In fact, over 28 million Medicare beneficiaries used telehealth services within the first year of the pandemic alone. So what was done to help rack up these staggering numbers so quickly? Let’s break down the timeline.
- March 2020. The Department of Health and Human Services waived a few of Medicare’s telehealth restrictions and expanded its coverage. Before these changes, Medicare only covered telehealth on a limited basis, such as when the patient was in a rural area.
- 2021/22 Consolidated Appropriations Acts: Telehealth services were further expanded to include more physical, occupational, and speech therapy resources. CMS gave a more comprehensive list of telehealth services payable under Medicare.
It is worth noting that the PHE has been extended multiple times since its inception. For example, it was renewed by the Department of Health and Human Services (HHS) secretary on July 15, 2022, adding to at least ten other emergency declarations since late January 2020.
Consequently, the support for telehealth to cover therapy and other practices has been maintained and even upgraded at several stages. But will telehealth continue receiving this attention in the coming years? Well considering the temporary nature of the PHE, which has been telehealth’s biggest driver yet, the future of these changes in Medicare coverage for telehealth services during Covid-19 is uncertain.
What are the Medicare Telehealth Billing Codes Available for Therapists?
Although Medicare will cover some codes permanently as stipulated in the Consolidated Appropriations Act, other services will only be included as long as the PHE declaration stands. Here are some medical codes you should be aware of while Medicare still offers coverage for telehealth, as presented by Telehealth.hhs.gov.
Telephone Visits
Payments for select evaluation and management phone visits were increased for Medicare beneficiaries, including Telehealth Current Procedural Terminology (CPT) codes 99443, 99442, and 99441. Additionally, reimbursements for in-person services increased to $60-$137 from the previous $14-$41.
Moreover, Medicare uses the same codes for Place of Service (POS) telehealth visits as the codes used when the services are delivered in person – however, therapists are expected to append modifier-95 for remote sessions.
Physical Therapy
According to CMS guidelines, physical therapists are eligible to bill Medicare for specific services furnished via telehealth, in which case the same rates as in-person visits apply.
The acceptable CPT codes are 97161-97164, 97110, 97116, 97530, 97535, 97535, 97542, 97750, 97755, 97760, and 97761 – all of which are only temporary additions so long as the PHE is in effect.
What’s more, CMS requires physical therapists to include the Healthcare Common Procedures Coding System (HCPCS) G-codes when they provide a telehealth service to an established patient for up to seven days:
- G2061: cumulative time of 5-10 minutes
- G2062: 11-20 minutes
- G2063: 21 minutes and above
As for modifiers, therapists are expected to use the same POS codes for services furnished via telehealth as you would during in-person visits. Modifier-95 is required to confirm telehealth services in addition to the CP modifier that proves the involvement of a physical therapist.
Check out Raintree’s telehealth list for more information on codes relevant to therapy and rehab, as well as clinical unit rules.
Advocate for Permanence of Telehealth Services for Medicare Beneficiaries
According to the Consolidated Appropriations Act of 2022, Medicare’s telehealth coverage will only extend about five months after the PHE has officially ended. This means many beneficiaries under the traditional Medicare coverage will lose access to most telehealth services.
You can help advocate for permanence and continued improvement of the current policies favoring telehealth coverage under Medicare through resources from the American Speech-Language-Hearing Association (ASHA), the American Physical Therapy Association (APTA), and the American Occupational Therapy Association (AOTA).
- APTA provides template letters you can send to your governor and state legislators.
- AOTA’s website offers a guide to help you write a letter to Congress.Â
- Send word to your member of Congress through a form fillable letter available on ASHA’s website.
As part of Raintree’s strategic partnership with APTQI, we share the common belief that quality healthcare should be accessible to all. Join us as we urge lawmakers to pass the Expanded Telehealth Access Act, a policy that would make temporary telehealth coverage permanent for outpatient therapists.
