The COVID-19 Public Health Emergency Waivers Q&A

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Last month we discussed that the COVID-19 Public Health Emergency (PHE) was extended for the tenth time through October 13, 2022, and that the telehealth waivers will remain in effect for 151 days after the PHE end date. We also addressed some of the most frequently asked telehealth coding and coverage questions. Since then, this author has received additional questions about what will happen to some other waivers when the PHE ends. This column will address those questions.

Q:      

Will the PHE be extended again after October 13, 2022?

A:       

A formal PHE announcement has not yet been released. However, this author is guessing that the PHE will be extended at least one more time. The basis for this guess is that the Secretary of the Health and Human Services promised the states and the health care community a 60-day notice before ending the PHE and this article was written less than 60 days from October 13, 2022. Therefore, the PHE is likely to be extended for another 90 days past October 13, 2022.

Q:      

Last month you answered questions about coding and billing for telehealth services during the PHE. You mentioned that the telehealth waivers will be active for 151 days after the end of the PHE. Because I have been performing certain services via telehealth during the PHE, will you please verify if these services will have the 151-day extension?

·      Initial nursing facility visits, all levels (low, moderate, and high complexity) and nursing facility discharge day management (99304–99306; 99315–99316; and G9685)
·      Domiciliary, rest home, or custodial care services, new and established patients (99324–99328; 99336–99337; NOTE: 99334 and 99335 were permanently added to the approved telehealth service)
·      Home visits, new and established patient, all levels (99341–99345; 99349; 99350; NOTE: 99347 and 99348 were permanently added to the approved telehealth services)
·      Telephone E/M (99441–99443)

A:       

To the best of this author’s knowledge, these services will be part of the 151-day telehealth extension. However, when you review the complete list of all Medicare telehealth services, you will see that some of them have specified end dates of December 31, 2023. Click here to view the entire list of Medicare telehealth services.

Q:      

I am a physical therapist and have been providing some therapy services via telehealth. Will you please verify that the following therapy services will receive the 151-day extension after the PHE ends: 97161–97164; 97110, 97112, 97116, 97530, 97535, 97750, 97755, 97760, 97761, 98960–98962?

A:       

As stated in the previous answer, I believe the 151-day extension applies to these therapy codes. However, when you review the complete list of all Medicare telehealth services, you will see that many of them have specified end dates of December 31, 2023.

Q:      

I am a physician who normally provides my wound/ulcer management work in a hospital owned outpatient wound/ulcer management provider-based department (PBD). During the PHE, I am providing many follow-up assessments to Medicare beneficiaries via telehealth. I report the place of service 22 On-campus outpatient hospital and Medicare pays the facility allowable rate. Will I be able to provide telehealth visits for these patients after the PHE ends?

A:       

Unfortunately, the answer is no. The hospital owned PBD is not normally an allowed originating telehealth site. Therefore, when the PHE ends, this flexibility will end. You will no longer be allowed to bill for telehealth provided in a patient’s home as if it were provided in the PBD.

Q:      

Prior to the PHE, I could only perform a subsequent nursing facility visit, to a Medicare beneficiary, once in 14 days. During the PHE, CMS allowed subsequent nursing facility visits to be performed via telehealth and removed the 14-day frequency restrictions for 99307–99310. What will happen after the PHE ends?

A:       

Unless CMS provides further direction, the 14-day frequency restriction will resume after the PHE ends.        

Q:      

I have been administering COVID-19 vaccines, without cost sharing, to Medicare patients in my office. Will I still be paid by Medicare Part B to administer the vaccines after the PHE ends?

A:       

Yes, you will continue to be paid approximately $40 per dose through the end of the calendar year that the PHE ends. Then, effective January 1 of the year after the PHE ends, CMS will establish an administration payment rate that aligns with payment for administering other Part B preventive vaccines.

Q:      

During the PHE, I have been doing many home visits for my patients with chronic wounds/ulcers. I have also been administering COVID-19 vaccines and boosters to certain Medicare beneficiaries at home. Medicare has been paying me an additional $35.50 per dose. When the PHE ends, will Medicare pay the same rate for administering the vaccine in the home?

A:       

CMS says they will continue to pay approximately $75 per dose to administer COVID-19 vaccines to certain patients in their homes, but that payment will cease at the end of the calendar year that the PHE ends.   

Q:      

I heard that Medicare e-visits do not fall under the telehealth regulations. Will you please remind me about the correct codes for physicians/QHPs and for physical therapists to use during the PHE?

A:      

During the PHE Medicare pays physicians/QHPs for remote evaluation of new and established patient video/images and virtual check-in services reported with HCPCS codes G2010 and G2012.

Also, during the PHE, licensed physical therapists can provide non-face-to-face e-visits using online patient portals. When physical therapists perform that work, they should report the HCPCS codes G2250–G2251.

Q:      

During the PHE, can physicians/QHPs obtain annual beneficiary consent for virtual check-ins at the same time that the services are performed?

A:       

Yes, CMS allows that flexibility for both new and established patients during the PHE, but the flexibility will most likely end when the PHE ends.

Q:      

When the PHE ends, will I still be able to offer remote physiologic monitoring (RPM) to both new and established patients and for both acute and chronic conditions?

A:       

Allowing clinicians to bill for RPM for both new and established patients during the PHE is definitely part of the waiver program. When the PHE ends, clinicians will only be able to provide RPM for established patients.

CMS did announce that after the PHE it will allow RPM services for patients with acute and chronic conditions.

Q:      

I am the program director for several PBDs that are either on-campus or excepted off-campus departments. During the PHE, we relocated many patients’ wound/ulcer management services to their homes by receiving an extraordinary circumstances relocation approval, which is consistent with our state emergency preparedness/pandemic plan. I understand that Medicare has been paying the relocated on-campus departments and the excepted off-campus department the full Outpatient Prospective Payment System (OPPS) Allowable rates because the extraordinary circumstances relocation requests were approved. Will we be able to perform these services in the patients’ homes after the PHE?

A:       

As far as this author can tell, CMS expects the relocated PBD services to cease and return to their original location when the PHE ends.          

NOTE: This author is under the impression that the excepted off-campus department is paid the full OPPS allowable rate for all services except clinic visits, which are paid at approximately 40% of the OPPS rate.

Q:      

I am the owner of a durable medical equipment (DME) supplier that supplies surgical dressings and negative pressure wound therapy pumps and supplies. Obtaining patients signatures and following proof of delivery requirements has always been problematic for DME suppliers. During the PHE, when a signature cannot be obtained, CMS waived the signature and proof of delivery requirements as long as the DME supplier documented in the medical record the appropriate date of delivery and that a signature was not obtained because of the PHE. What will happen to that flexibility when the PHE ends?

A:       

This author realizes that you are hoping for a different answer, but CMS has stated that the signature and proof of delivery requirements will be reestablished when the PHE ends.

Summary

All professionals, providers, and suppliers should continue to use the COVID-10 PHE waivers to provide Medicare beneficiaries with the best possible wound/ulcer management during the PHE—no matter how long the PHE lasts. In addition, everyone should keep track of which waivers will end, which will continue and for how long, and which waivers will become permanent.

The CMS has worked hard to keep all health care stakeholders apprised about the status of the waivers. In fact, on August 18, 2022 CMS released an excellent update entitled “Creating a Roadmap for the End of the COVID-19 Public Health Emergency,” which can be found here. Because this roadmap reviews the waiver flexibilities in fact sheets for each provider type, this author found the specific fact sheets easy to use and to understand. Therefore, this author highly recommends that wound/ulcer management stakeholders, no matter which place of service you work, take the time to read the roadmap update and then to scroll to the bottom of the document and click on the fact sheet(s) that pertain(s) to you.

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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