Medicare telehealth services in 2022

Question: Has the Medicare telemedicine list changed for 2022?

Answer: As Centers for Medicare and Medicaid Services (CMS) continues to evaluate the inclusion of telehealth services that were temporarily added to the Medicare telehealth services list during the COVID-19 public health emergency, they have finalized that certain services added to the Medicare telehealth services list will remain on the list through December 31, 2023.

This will allow additional time for CMS to evaluate whether each service should be permanently added to the Medicare telehealth services list.

CMS finalized that they will extend, through the end of CY 2023, the inclusion on the Medicare telehealth services list of certain services added temporarily to the telehealth services list that would otherwise have been removed from the list as of the later of the end of the COVID-19 PHE or December 31, 2021. They also have extended inclusion of certain cardiac and intensive cardiac rehabilitation codes through the end of CY 2023. This will allow for more time for CMS to gather data to decide whether or not each telehealth service will be permanently added to the Medicare telehealth services list.

Additionally, CMS is adopting coding and payment for a longer virtual check-in service on a permanent basis.

Section 123 of the Consolidated Appropriations Act (CAA) removed the geographic restrictions and added the home of the beneficiary as a permissible originating site for telehealth services furnished for the purposes of diagnosis, evaluation or treatment of a mental health disorder. Section 123 requires for these services that there must be an in-person, non-telehealth service with the physician or practitioner within six months prior to the initial telehealth service and an in-person, non-telehealth visit must be furnished at least every 12 months for these services.

Exceptions to the in-person visit requirement may be made based on beneficiary circumstances (with the reason documented in the patient’s medical record), and that more frequent visits are also allowed under the policy, as driven by clinical needs on a case-by-case basis.

CMS has amended the current definition of interactive telecommunications system for telehealth services (which is defined as multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner) to include audio-only communications technology when used for telehealth services for the diagnosis, evaluation or treatment of mental health disorders furnished to established patients in their homes under certain circumstances.

CMS is limiting the use of an audio-only interactive telecommunications system to mental health services furnished by practitioners who have the capability to furnish two-way, audio/video communications, but where the beneficiary is not capable of, or does not consent to, the use of two-way, audio/video technology.

CMS also finalized a requirement for the use of a new modifier for services furnished using audio-only communications, which would serve to verify that the practitioner had the capability to provide two-way, audio/video technology, but instead, used audio-only technology due to beneficiary choice or limitations. They are also clarifying that mental health services can include services for treatment of substance use disorders (SUDs).

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

“Synchronous telemedicine service” is defined as a real-time interaction between a physician or other qualified health care professional (QHP) and a patient who is located away at a distant site from the physician or other QHP. The totality of the communication of information exchanged between the physician/QHP and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

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