CMS updates FAQ on PHE waivers and flexibilities

Wednesday, May 24, 2023

CMS recently updated an FAQ to clarify outpatient therapy and telehealth billing policies after the PHE conclusion.

Hospitals can continue to bill for outpatient therapy, diabetes self-management training (DSMT), and medical nutrition therapy (MNT) services furnished remotely through telecommunication technology in the same way were during the PHE until the end of calendar year (CY) 2023, according to the FAQ.

CMS said it will “exercise enforcement discretion in reviewing the telehealth practitioner status of the clinical staff personally providing any part of a remotely furnished DSMT service,” given all other criteria are met.

Other facilities that provide outpatient therapy, DSMT, and MNT services should continue to bill for them under the Medicare Physician Fee Schedule when remotely furnished as they were during the PHE, said CMS.

For home health agencies, all covered outpatient therapy, DSMT, and MNT services within a 30-day care period are part of a bundled prospective payment. These facilities will be required to report the use of telecommunications technology in providing these services on claims starting July 1, 2023, said CMS.

For skilled nursing facilities (SNF) and inpatient rehabilitation facilities (IRF), Part A-covered outpatient therapy, DSMT, and MNT services furnished via telehealth or with telecommunications technology are paid for by CMS through a bundled payment. These services “would not be separately billable for those patients in a Part-A covered SNF or IRF stay,” according to the FAQ.

During the PHE, CMS suspended the requirements that Current Procedural Terminology (CPT©) codes 99231-99233 and 99307-99309 may only be furnished via Medicare telehealth once every three and 14 days, respectively. CMS will not consider these frequency limitations through the end of CY 2023, according to the FAQ. The agency said it anticipates revisiting this policy in future regulations.

NAHRI provides the following additional resources on the end of COVID-19 waivers and flexibilities:

Outpatient therapy, DSMT, and MNT providers should closely review the updated FAQ to understand pertinent policies and timelines. Along with the updated FAQ, revenue integrity professionals should review previous CMS guidance on the PHE conclusion—including its provider-specific fact sheets and transition roadmap—to ensure their organization is in compliance. Use NAHRI’s resources as a framework for auditing and monitoring affected services.

Editor’s note: Find more NAHRI resources on COVID-19 here.