On November 2nd, 2021, CMS issued a final rule with updated Physician Fee Schedule policies for the upcoming year. We have previously covered some of the key 2022 Physician Fee Schedule proposed rule changes and American Telemedicine Association’s (ATA) comments, which you can revisit here.
While the process of evaluating whether certain telehealth services that were added during the COVID-19 public health emergency should be permanently included in the Medicare telehealth services list is still ongoing, such services will remain on the list until December 31, 2023, when the final decision is expected. The same applies to certain cardiac and intensive cardiac rehabilitation codes, which will also be preserved until 2023. In addition, CMS permanently adopted codes and payments for longer virtual check-in services.
When it comes to telemental services, the previously enforced geographic restrictions were removed, and home of the beneficiary was added as acceptable originating site for the purposes of diagnosis, evaluation, and treatment of a mental health disorder. The six-month rule was amended with a new rule that requires an in-person, non-telehealth visit at least once every 12 months. The rule includes additional clarification stating that mental health services can also include treatment for substance use disorders.
The current definition of an interactive telecommunications system for telehealth services was also amended to include audio-only technology when furnishing telemental services to established patients. Inclusion of audio-only services pertains to only mental health services – and there is a new modifier for services furnished via audio-only that will be used to verify that the provider has the ability to provide two-way, audio/video technology, but used audio-only due to beneficiary choice or limitations.
As part of this final rule, CMS stated that they are dedicated to improving access to remote therapeutic monitoring (RTM) in the future.
Remote Physiological Monitoring (RPM) was not addressed in the final rule.
American Telemedicine Association (ATA) has shared its response to the final rule:
“We are encouraged to see this final PFS reflects CMS’ continued interest in ensuring access to telehealth for Medicare beneficiaries. This final rule underscores the critical role virtual care plays in our healthcare system and we commend the administration for its important efforts to ensure telehealth services are positioned to provide patients quality care.” said Kyle Zebley, Vice President of Public Policy, the ATA.
Furthermore, ATA stated their appreciation for the improvements of the final rule as opposed to the proposed rule, they urge Congress to remove in-person requirements that limits access to essential elemental services.
In their response, ATA also addressed the extension of temporary telehealth services until December 31st, 2023:
“We are pleased that the Category 3 codes remain in place to ensure continued coverage for Medicare beneficiaries, though we recognize restrictions will be implemented if the public health emergency ends despite the provisions in the PFS. The ATA supports comprehensive telehealth reform bills, such as the CONNECT for Health Act (S. 1512, H.R. 2903), to maintain access to telehealth services beyond the public health emergency.”