The COVID-19 Public Health Emergency Extension Also Applies to Telehealth

Information regarding coding, coverage, and payment is provided as a service to our readers. Every effort has been made to ensure accuracy. However, HMP and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received.

On July 15, 2022, the COVID-19 Public Health Emergency (PHE) was extended through October 13, 2022—that was the tenth extension of this PHE. Many wound/ulcer management professionals have been using telehealth and should be happy to know that the Medicare waivers pertaining to telehealth have also been extended.

However, some private payers and some states have already rescinded their lenient telehealth waivers. Therefore, wound/ulcer management professionals should verify the telehealth policies of pertinent private payers and should monitor the telehealth regulations in their individual states.

Even though much has been written about coding and Medicare coverage for telehealth services, wound/ulcer management professionals continue to submit many questions to this author. In addition, numerous telehealth audits have been and continue to be conducted by the payers and by the Office of Inspector General (OIG).

Therefore, this column will address some of the most frequently asked telehealth coding and coverage questions, which should guide you to receive appropriate Medicare payment, and to pass telehealth-related audits.

Q:       During the PHE, if the patient’s home is the originating site, who should report Q3014 Telehealth originating site facility fee?

A:       Because the patient’s home is not a facility, no one should report Q3014 to Medicare during the PHE when the patient’s home is the originating site.

Q:       I reported the Place of Service code 02 to indicate that I provided wound/ulcer assessments and management via telehealth rather than in my office. I received the lower facility Medicare payment rate for my work. I thought I was supposed to receive my normal office Medicare payment during the PHE. Do you have any idea why that happened and what I should do to correct it in the future?

A:       As the distant site physician, you should have reported 3 important codes on your Medicare claim:
                      1.         Reported the code for the Medicare eligible telehealth service performed. Medicare has identified nearly 200 codes that can be performed via telehealth during the PHE, such as 99202–99215, and 99441–99443. You can view a complete list of the telehealth services that are Medicare eligible during the PHE here.
                      2.         Attached modifier -95 to indicate that the service rendered was performed via telehealth under a COVID-19 PHE waiver.
                      3.         Reported the Place of Service code that would have been reported for an in-person visit. NOTE: This was the error that caused your claims to be paid at the lower facility rate. Because you normally provided care to the patients in your office, you should have reported Place of Service Code 11.

Q:       I am a podiatrist who normally sees patients with wounds/ulcers in my office. During the PHE, I have been performing telehealth E/M services for some of these patients who do not require diagnostic tests and/or procedures. However, I have been conducting the telehealth encounters from my home. What place of service should I report?

A:       Thanks to the COVID-19 PHE waivers, you should still report the place of service code 11 because you normally see those patients in your office. To identify the encounter as a telehealth service provided during the PHE, you should also append modifier -95 to the appropriate E/M code. If you meet all the coverage criteria and document thoroughly, Medicare should pay you for the telehealth encounter based on the 2022 Medicare Physician Fee Schedule (MPFS) allowable rates for the office.

Q:       I am a physical therapist and would like to know if Medicare includes therapists as covered distant site practitioners.

A:       Under normal conditions, Medicare does not include therapists on the list of covered distant site practitioners (physicians, nurse practitioners, physician assistants, nurse midwives, clinical nurse specialists, certified registered nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals). However, the COVID-19 PHE waivers allow all health care practitioners (such as physical therapists and occupational therapists) who are authorized to bill Medicare to provide telehealth services that are on the list of Medicare eligible telehealth services. Therefore, physical therapists should check to see if the pertinent codes are on the list.

Q:       During a recent audit of Medicare claims for telehealth services that I provided for patients I normally see in my office, I had to repay every claim because I did not document that the patient consented to the telehealth service. That does not make sense to me because I would not have been able to perform a telehealth service if the patient did not agree. Will you please explain?

A:        Medicare beneficiaries must consent to telehealth services. Prior to the COVID-19 PHE, written consent was required before a telehealth service was performed. During the PHE, verbal or written consent is required and can be obtained at the time the telehealth service is arranged by ancillary personnel working under general supervision, or during the telehealth service. However, in both cases, the patient’s consent must be obtained once per year and must be documented in the patient’s medical record. NOTE: During the consent process, the provider must inform the Medicare beneficiary that she/he will owe a co-payment for the telehealth service, just like for in-person services.

Q:       I provided a level 3 evaluation and management (E/M) service to an established patient via the phone because the patient did not have video access. I reported 99213–95 and my coder changed the code to 99441–95. Was the coder correct to change the code?

A:       Yes, your coder was correct. Telehealth office visit codes (99202–99215) can only be reported when a two-way real-time audio/video communication took place. Because you only had an audio communication with the patient, you should have reported one of the telephone E/M codes (99441–99443). These codes are based on documented medical discussion time: 99441 for 5–10 minutes; 99442 for 11–20 minutes; and 99443 for 21–30 minutes. Therefore, it is essential that you document time spent on audio-only telehealth visits.
            NOTE: If you begin an audio/video telehealth E/M, and you lose the video connection, you must report that telehealth encounter with one of the telephone E/M codes. As stated above, you should document the time spent during the encounter that turned into an audio-only telehealth visit.

Q:       Do the telephone E/M codes have allowable rates on the 2022 Medicare Physician Fee Schedule (MPFS)?

A:       Yes, 99441–99443 have published allowable rates on the 2022 MPFS. The national average allowable rates are:

 
Q:       During the COVID-19 PHE, does Medicare allow all the codes on the Medicare list of eligible telehealth services to be provided audio-only?

A:        No, only some eligible telehealth services can be performed audio-only. You can easily identify those codes and services by looking in the fourth column of the eligible telehealth services file. That column is labeled with a question: “Can audio-only meet the interaction requirements?” If the word “yes” appears in that column for a particular code/service, Medicare believes it can be performed audio-only.

Q:       My coder insists that I can only provide telehealth E/M services for established patients. I thought I read that I could also provide telehealth E/M services for new patients. Who is correct?

A:       Your coder was correct before the COVID-19 PHE waivers were implemented. However, you are correct because the waivers allow telehealth E/M services for new patients during the PHE.

Q:       When the COVID-19 PHE ends, will the telehealth waivers abruptly end?

A:       Thanks to the Consolidation Appropriations Act that was enacted in March 2022, the COVID-19 PHE telehealth waivers will remain in effect for 151 days after the PHE end date. In addition, due to the massive support from physicians, lawmakers, and patients, we may see a new law that extends Medicare telehealth payment and regulatory flexibility through the end of 2024. Keep your eye on the news!

Kathleen D. Schaum is a founding member of the Today’s Wound Clinic editorial advisory board and oversees a consulting business. She can be reached for consultation and questions by emailing kathleendschaum@bellsouth.net.

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