Telehealth and the End of the Public Health Emergency: Answers to Common Questions
Many telehealth flexibilities remain in place after the end of the public health emergency in May 2023. Learn about changes that may require adjustment and what stayed the same.
This information is based on Medicare regulations. Medicare Advantage plans may offer additional benefits, and many private payers have already adopted permanent telehealth policies. Check with your local provider relations representatives for their telehealth coverage and payment policies.
For outpatient telehealth services, Medicare’s coverage largely remains the same after the end of the COVID-19 public health emergency. The Consolidated Appropriations Act of 2023 (CAA) extended many telehealth flexibilities through the end of 2024. These flexibilities include eliminating the originating and geographic site restrictions. Patients may continue to receive telehealth services in any geographic area in the United States, and they may remain in their home rather than going to a health care facility. The CAA also extended coverage of certain audio-only services.
A list of Medicare’s telehealth services, including services that can be provided via audio-only telecommunications technology, is available as a zipped file from CMS. Medicare notes that it will revisit this list in the Calendar Year (CY) 2024 Medicare Physician Fee Schedule (MPFS).
The Hospitals Without Walls Initiative expanded the definition of a provider-based department to include the beneficiary’s home. This initiative will expire when the PHE ends, and hospitals will no longer be allowed to bill for the originating site facility fee (HCPCS code Q3014), clinic visit (HCPCS G0463), and remote mental health services (HCPCS codes C7900-C7902) unless the patient is located within a hospital and the beneficiary receives the service from an eligible distant site practitioner.
Yes. Medicare will cover certain services when provided via audio-only communications technology, including telephone evaluation and management services (CPT codes 99441-99443).
A list of Medicare’s telehealth services, including services that can be provided via audio-only telecommunications technology, is available as a zipped folder. Medicare notes that it will revisit this list in the Calendar Year (CY) 2024 Medicare Physician Fee Schedule (MPFS).
Most private payers cover audio-only services. Review the AAFP’s telehealth coding scenarios for billing information and check with your local provider relations representatives for information regarding their audio-only policies.
Yes. The Consolidated Appropriations Act of 2023 included provisions that allow FQHCs and RHCs to serve as distant site providers for non-behavioral/mental health services through the end of 2024. Additionally, the 2023 Medicare Physician Fee Schedule included a policy that permanently allows FQHCs and RHCs to serve as distant site providers for behavioral/mental health services
FQHCs and RHCs may furnish for telehealth services included on the list of Medicare telehealth services using HCPCS code G2025. FQHCs and RHCs may also provide virtual communications services using HCPCS code G0071. However, after May 11, 2023, HCPCS code G0071 no longer includes online E/M services (CPT codes 99421-99423) and may only be provided to established patients. Additionally, consent will require direct supervision.
Yes. CMS will continue exercising enforcement discretion and will not consider frequency limitations for these codes through December 31, 2023. CMS intends to consider the policy further through the rulemaking process.
No. Beginning on May 12, 2023, RPM (CPT codes 99453 and 99454), remote evaluations and virtual check-ins (HCPCS codes G2010 and G2012), and e-visits (CPT codes 99421-99423) may only be provided to established patients. Additionally, physicians may continue to obtain consent at the time of service. However, states may have their own consent requirements. For information on the requirements for your state, visit the Center for Connected Health Policy.
Yes. During the PHE, Medicare allowed RPM services to be billed when a minimum of two days of data was collected. Beginning on May 12, 2023, the data requirements for RPM services (CPT codes 99453 and 99454) returned to their pre-PHE requirements and may not be reported if fewer than 16 days of data are collected.
Yes. Medicare will continue to pay telehealth services at the same rate as it would have if the service had been provided in-person through the end of 2023. Additionally, the telephone evaluation and management (E/M) services (CPT codes 99441-99443) will continue to be paid at parity with office visit established patient E/M codes of comparable length. Medicare payment rates may be found using the Medicare Physician Fee Schedule Look-up Tool.
Based on current regulations, Medicare will revert to its pre-PHE policies on January 1, 2024, meaning telehealth services will be paid at the facility rate rather than the non-facility rate. The Centers for Medicare & Medicaid Services (CMS) has not indicated whether it will change this policy, though more information should be available in the CY 2024 Medicare Physician Fee Schedule.
Telehealth Collection: Resources on the basics, workflow, billing, and more
For traditional Medicare patients, you should continue to use the place of service you would have had the service been provided in-person and append modifier “95.” You should append modifier “FQ” for Medicare services provided via audio-only communications technology. For mental health services furnished via audio-only communications technology, you can append either the “FQ” or “93” modifier.
Find more articles on billing and coding for telehealth services.
No. Beginning May 12, 2024, practices are no longer allowed to waive cost-sharing for telehealth services provided to Medicare beneficiaries.
Beginning January 1, 2025, patients receiving tele-behavioral health services will require an in-person visit at least once within six months of initiating services and every 12 months thereafter.
During the COVID-19 PHE, CMS provided flexibility for certain clinical indications for coverage in certain National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs). This provided physicians more flexibility to prescribe durable medical equipment (DME) such as continuous glucose monitors (CGM) without first having an in-person visit. After the expiration of the COVID-19 PHE, in-person, face-to-face visits will be required for applicable NCDs and LCDs. For example, beneficiaries must have an in-person or Medicare-approved telehealth visit to receive CGM.
Telehealth is considered rendered at the physical location of the patient, meaning the physician typically needs to be licensed in the state in which the patient is physically located, with few exceptions. Some states offered exceptions during the COVID-19 PHE. However, most expired when the PHE expired on May 11, 2023.
For Medicare patients, physicians must be licensed to practice medicine by the state in which they perform their services.
For additional information regarding licensure requirements for your state, visit the Center for Connected Health Policy: Medicaid & Medicare Out of State Providers and Center for Connected Health Policy: Professional Requirements Cross-State Licensing.
Learn more about legal requirements in your state from the AAFP.
The Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) have extended the full set of telemedicine flexibilities regarding the prescribing of controlled medications through November 11, 2023. Practitioner-patient telemedicine relationships established before November 11, 2023, will have an additional year (i.e., until November 11, 2024) to continue using telemedicine flexibilities for controlled medications that were in place during the COVID-19 PHE.
Beginning May 12, 2023, only teaching physicians in residency training sites located outside of a metropolitan statistical area may provide virtual supervision through audio-video real-time communications technology.
Additionally, teaching physicians can only bill for level 4 or level 5 office visit E/M services furnished by residents if the teaching physician is physically present for the key portion of the service.
For more information on virtual direct supervision requirements, review the AAFP's Resident Supervision Post-PHE (PDF).
During the COVID-19 PHE, the Office for Civil Rights (OCR) exercised enforcement discretion, meaning they would not impose penalties on covered entities for certain HIPAA violations such as using non-HIPAA-compliant telecommunications technology. OCR will resume its enforcement of HIPAA requirements starting August 10, 2023.
For tips on how to prepare for the end of HIPAA enforcement discretion, read FPM’s Quick Tips Blog "Post-PHE telehealth HIPAA enforcement begins in August. Here's how practices can prepare."
Learn how telemedicine can help simplify your practice.