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On April 12, 2022, Xavier Becerra, Secretary of Health and Human Services, renewed the COVID-related Public Health Emergency (PHE), effective April 16, 2022. The PHE has officially been extended another 90 days. Details can be seen on the website of the Assitant Secretary for Preparedness and Response. This action has solidified the forward movement toward telehealth reimbursement, other telehealth funding for rural areas, and the MedPAC report for further telehealth reimbursement, including the 99441 CPT code reimbursement for audio-only telehealth.
Expansion of Telehealth Reimbursement
On March 16, 2022, President Biden signed the Consolidated Appropriations Act. The Act extends by 151 days (5 months) the Medicare telehealth waivers and flexibilities introduced during Covid-19, including telehealth reimbursement, PHE location, provider type, and audio-only telehealth expansions. The Act includes the following changes:
- Location – Medicare beneficiaries will continue to enjoy remote health services from any location in the country.
- Qualifying practitioners, including physical therapists, occupational therapists, qualified audiologists, and speech-language pathologists, can continue to offer telehealth services. The extension also includes rural health clinics and federally qualified health centers.
- Audio-only telehealth requirement – Medicare will continue with audio-only telehealth reimbursement for 151 days. The only telehealth funding exception will be for services that the Counsel for Medical Schemes expressly directs in real-time.
- Hospice recertification is extended.
Telehealth Funding for Rural Services
In line with the CAA, telehealth funding allocations of more than $62 million from the federal budget will go to grants for rural services. The funds will finance the facilities and systems needed to supply telehealth services in rural areas. The time extension of telehealth flexibilities is welcome. It also indicates that the debate over the permanent implementation of telehealth funding will continue into the foreseeable future.
MedPAC Report Recommendations for Telehealth Funding
Medicare Payment Advisory Commission (MedPAC)’s recently released March 2022 Report to Congress: Medicare Payment Policy addresses future healthcare policies. The Medicare Payment Advisory Commission (MedPAC) is an independent, non-partisan legislative branch agency. It also covers several telehealth funding concerns and suggestions. The report’s standout feature is the proposal that the Centers for Medicare and Medicaid Services (CMS) include a modifier for telehealth reimbursement claims. As discussed in other Telehealth.org reports, the official Place of Service (POS) modifier to be used starting April 2022 is “02-Telehealth.”
The modifier will track specific data related to telehealth diagnoses. MedPAC also wants home health agencies and hospice providers to include any provided telehealth services on their Medicare claims. The aim is to use this information to understand better telehealth’s impact on quality, health, and access to service. It will help to establish payment accuracy for telehealth reimbursement. Currently, a lack of consistency in collecting information limits the tracking of audio-only telehealth services. Though the March 2022 report makes recommendations, it fails to address the time and effort needed to collect the data.
Telehealth audio-only CPT codes are 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (20-30 minutes). Reimbursements match similar in-person services, increasing from about $14-$41 to about $60-$137, retroactive to March 1, 2020. Reimbursement for the 99441 audio-only evaluation and management (E/M) services facility fees starts at $46.13 for non-facility fees and $26.32 for facility fees.
Recent Telehealth Statistics
The Medicare Payment Policy reports the following statistics:
- 50% of beneficiaries have used telehealth to access healthcare over the past year.
- Almost half of Medicare members have used telehealth over the past year.
- Audio-only telehealth visits were the most popular. 37% of older people used the service.
- 23% of Medicare beneficiaries prefer interactive video healthcare.
- 86% of telehealth users enjoy the service and would like to continue to use it once Covid-19 has passed.
