Medicare telehealth providers in 2022

Question: Has the Medicare telemedicine record modified for 2022?

Answer: As Centers for Medicare and Medicaid Services (CMS) continues to judge the inclusion of telehealth providers that have been briefly added to the Medicare telehealth providers record through the COVID-19 public well being emergency, they’ve finalized that sure providers added to the Medicare telehealth providers record will stay on the record by way of December 31, 2023.

This will enable extra time for CMS to judge whether or not every service must be completely added to the Medicare telehealth providers record.

CMS finalized that they’ll lengthen, by way of the top of CY 2023, the inclusion on the Medicare telehealth providers record of sure providers added briefly to the telehealth providers record that will in any other case have been faraway from the record as of the later of the top of the COVID-19 PHE or December 31, 2021. They even have prolonged inclusion of sure cardiac and intensive cardiac rehabilitation codes by way of the top of CY 2023. This will enable for extra time for CMS to assemble knowledge to determine whether or not or not every telehealth service might be completely added to the Medicare telehealth providers record.

Additionally, CMS is adopting coding and fee for an extended digital check-in service on a everlasting foundation.

Section 123 of the Consolidated Appropriations Act (CAA) eliminated the geographic restrictions and added the house of the beneficiary as a permissible originating website for telehealth providers furnished for the needs of analysis, analysis or therapy of a psychological well being dysfunction. Section 123 requires for these providers that there have to be an in-person, non-telehealth service with the doctor or practitioner inside six months previous to the preliminary telehealth service and an in-person, non-telehealth go to have to be furnished no less than each 12 months for these providers.

Exceptions to the in-person go to requirement could also be made based mostly on beneficiary circumstances (with the explanation documented within the affected person’s medical report), and that extra frequent visits are additionally allowed below the coverage, as pushed by scientific wants on a case-by-case foundation.

CMS has amended the present definition of interactive telecommunications system for telehealth providers (which is outlined as multimedia communications tools that features, at a minimal, audio and video tools allowing two-way, real-time interactive communication between the affected person and distant website doctor or practitioner) to embrace audio-only communications expertise when used for telehealth providers for the analysis, analysis or therapy of psychological well being problems furnished to established sufferers of their houses below sure circumstances.

CMS is limiting the usage of an audio-only interactive telecommunications system to psychological well being providers furnished by practitioners who’ve the potential to furnish two-way, audio/video communications, however the place the beneficiary just isn’t able to, or doesn’t consent to, the usage of two-way, audio/video expertise.

CMS additionally finalized a requirement for the usage of a brand new modifier for providers furnished utilizing audio-only communications, which might serve to confirm that the practitioner had the potential to supply two-way, audio/video expertise, however as a substitute, used audio-only expertise on account of beneficiary alternative or limitations. They are additionally clarifying that psychological well being providers can embrace providers for therapy of substance use problems (SUDs).

The new modifier — Modifier 93 – Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System – is efficient January 1, 2022.

“Synchronous telemedicine service” is outlined as a real-time interplay between a doctor or different certified well being care skilled (QHP) and a affected person who’s positioned away at a distant website from the doctor or different QHP. The totality of the communication of data exchanged between the doctor/QHP and the affected person through the course of the synchronous telemedicine service have to be of an quantity and nature that’s enough to satisfy the important thing elements and/or necessities of the identical service when rendered through a face-to-face interplay.

Renee Dowling is a compliance auditor for Sansum Clinic, LLC, in Santa Barbara, California.

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