Billing Telehealth Updates for the South Central Region – November 2021

The Arkansas, Tennessee, and Mississippi Virtual Visit Billing Guides have been updated with significant telehealth policy changes!

Medicare had the most significant updates this month, as CMS released the 2022 Physician Fee Schedule Final Rule, which contained several telehealth changes.  The most significant change was expanded access to mental health telehealth services.  CMS permanently removed the originating site restriction for tele-mental health services, allowing tele-mental health to be performed from a patient’s home even after the federal PHE ends.  CMS also permanently added RHCs/FQHCs as distant site providers for tele-mental services.  Furthermore, CMS redefined their definition of “interactive telecommunications system” to include interactive, real-time, two-way audio-only technology for telehealth services for mental health disorders. Unfortunately, CMS still did not permanently remove the originating site restriction from all telehealth, therefore once the PHE ends, patients will no longer be able to seek telehealth services from their homes, unless it is for mental health. Along with the expanded mental health access, Medicare did add some additional telehealth category 3 codes, which are detailed below.

Medicaid also had a significant update. Mississippi’s state of emergency ended November 20^th, 2021, which resulted in the end of their temporarily allowable telehealth codes.  These temporarily allowable codes were e-visit and telephone codes.  Medicaid Arkansas’ COVID-19 telehealth flexibilities are still set to end December 31^st, 2021, which includes the originating site requirement waiver.  If AR Medicaid’s flexibilities do expire, then telehealth would no longer be allowed when the patient is located at home. We will be monitoring closely for extensions.

Below are the detailed updates:

MEDICARE

• Extended category 3 telehealth services until December 31^st, 2023
• New Category 3 telehealth services:
  • 93797-Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session
  • 93798-Physician or other qualified health care professional services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session
  • G0442-Intensive cardiac rehabilitation; with or without continuous EKG monitoring with exercise, per session
  • G0423-Intensive cardiac rehabilitation; with or without continuous EKG monitoring; without exercise, per session
• CMS added “patient’s home” as an originating site for patients receiving mental health services via telehealth. “Home” includes temporary lodging. Must meet the following requirements:
  • The provider (or another provider in the same practice and subspecialty) has conducted an in-person (non-telehealth) visit within 6 months
  • The services are medically necessary
  • After the initial tele-mental health visit, the provider must conduct an in-person visit at least once every 12 months
    • However, this visit is not required if the patient and provider consider the risks of an in-person visit and agree that the risks outweigh the benefits
    • Provider should document decision in the patient’s medical record
  • Medicare redefined “interactive telecommunications system” definition to include interactive, real-time, two-way audio-only technology for telehealth services for mental health disorders
    • Audio only mental health telehealth will be reimbursable if:
      • The provider has the technical capability, at the time of the service, to use an audio visual connection
      • The patient is incapable of, or fails to consent to, the use of video
      • The beneficiary is located in their home
      • The provider documents the reason for using audio-only technology
      • Appropriate modifier is used
    • Medical Nutrition therapy and diabetic self-management training services can be provided via telehealth when registered dietitians or nutrition professionals act as distant site practitioners
    • CMS will continue to allow mental health telehealth services, performed by an RHC/FQHC, even after the PHE ends.
      • The service must be either audio-visual OR
      • Audio-only, IF the following are present:
        • The patient is incapable of, or fails to consent to, the use of video technology for the service
        • The provider has conducted an in-person visit within the last 6 months of the initial tele-mental service
        • The services are medical necessary
        • After the initial telehealth visit, the provider conducts an in-person visit at least once every 12 months of each tele-mental visit.
          • However, if the patient and provider consider the risks of an in person service and agree that these risks outweigh the benefits, then the annual visit may be skipped.

Providers must document the decision

MEDICAID

• Arkansas:
  • All of AR Medicaid’s COVID-19 telehealth flexibilities are set to end December 31^st, 2021, including:
    • Originating Site Requirement Waiver
    • Professional Relationship Waiver
    • Parental Consultation Telehealth
    • Individual Therapy Services Telehealth
    • Applied Behavioral Analysis (ABA) Telehealth
    • Virtual Check-Ins (G2012) Telehealth
    • Behavioral Health Telehealth
  • Will continue to monitor to see if certain flexibilities will be extended, particularly the originating site requirement waiver, which allows telehealth to be provided when the patient is at home.
• Mississippi:
  • The Mississippi Division of Medicaid (DOM) is ending coverage of the temporary codes effective Friday, Nov. 20, 2021, which aligns with the end of Mississippi’s COVID-19 State of Emergency.  These temporary codes include telephone and virtual check-ins.