Medicare Reimbursement for Rehabilitation Telehealth Service: Sifting Through the Rumors and Half Truths

My name is Kathy Wibberly and I am Director of the Mid-Atlantic Telehealth Resource Center.   Today we are going to try to address some of the confusion that is out there related to Medicare telehealth reimbursement for PT, OT and SLP practitioners.  

I am employed by a hospital as a PT or OT or SLP.  My hospital told me that once the PHE ended, I could no longer provide telehealth to my therapy patients and that I needed to bring all my therapy patients into the hospital clinic.  Is that true?  Under the “Hospitals Without Walls” flexibility during the PHE, hospitals were allowed to treat patient’s homes as an extension of the hospital outpatient department.  Therefore, hospital services like remote Outpatient Therapy Services, when provided by hospital-employed therapists (PTs, OTs and SLPs) could be billed as if the patient were receiving the services at the hospital outpatient clinic.  The “Hospitals Without Walls flexibility” ended at the end of the PHE which took place on May 11, 2023.  HOWEVER, CMS issued updated guidance (item #21) on Friday May 12, 2023 extending flexibilities for remote therapy services for hospital-based outpatient departments through December 31, 2023.  As such, PT, OT and SLP providers may continue to bill for these hospital outpatient therapy services when furnished remotely in the same way they have been during the PHE through December 31, 2023.

I was under the impression that under the Consolidated Appropriations Act of 2023, CMS extended telehealth eligibility for PT, OT and SLP practitioners through December 31, 2024?   Yes, while it is true that Congress authorized PT, OT and SLP practitioners as eligible telehealth service providers under Medicare through the end of 2024, CMS has interpreted this within the context of independent providers filing claims on the 1500 claim form.  CMS has excluded telehealth as a billable service for PT, OT and SLP practitioners when they are considered institutional providers (those who bill on a UB04 claim form).  For a more in-depth discussion of the issue, read this American Occupational Therapy Association (AOTA), American Physical Therapy Association (APTA) and American Speech-Language-Hearing Association (ASHA) joint letter to CMS.

I am a PT, OT or SLP employed by a Skilled Nursing Facility/Rehab Facility.  This means I am neither an independent practitioner nor employed by a hospital-based outpatient department.  Can I still continue providing and billing for telehealth services?   CMS issued updated guidance (item #22) on Friday May 19, 2023 extending flexibilities for remote therapy services for other facility based providers.  Specifically, the guidance indicates says that:

For outpatient therapy services furnished remotely by institutional providers of therapy services such as rehabilitation agencies and comprehensive outpatient rehabilitation facilities should continue to be furnished and billed the same way they have been during the PHE, which can include the use of telecommunications technology and when billed on institutional claims forms.

For Home Health Agencies (HHAs), all services within a 30-day period of care are part of a bundled prospective payment.  As was the case during the PHE, while CMS allows services to be furnished via a telecommunications system so long as the services are included in a beneficiary’s plan of care, these services cannot be considered a “visit” for purposes of patient eligibility or payment per Medicare law, nor can they substitute for a home visit as ordered on the plan of care.  Medicare is requiring HHAs to report the use of telecommunications technology in providing home health services on home health payment claims on July 1, 2023 and HHAs may voluntarily report this information until that time.

For Skilled Nursing Facilities (SNFs) and inpatient rehabilitation facilities (IRFs), under Part A, CMS pays through a bundled payment for all covered Part A services.  To the extent that therapy services furnished via telehealth or telecommunications technology are covered Part A services, then these services would be considered part of the bundled prospective payment system payment under Part A.”

While CMS provided an end-date of December 31, 2023 for remote therapy services for hospital-based outpatient departments, they have not specified an end date for these other types of institutional practitioners.

——————————————————————————————-

For future updates from CMS, visit:  https://www.cms.gov/files/document/frequently-asked-questions-cms-waivers-flexibilities-and-end-covid-19-public-health-emergency.pdf