Navigating the Changes in Telehealth Regulation: What Every Provider Needs to Know

Mohammed Y. Chowdhury, MD
Director, CDI PRCM

Telehealth was a lifesaver during the COVID-19 pandemic, and it’s become a viable care option even in our post-PHE (public health emergency) world. And for good reason, since it can increase access to care, reduce costs, enable high-quality encounters, and provide added convenience for both patients and providers.

Now that the PHE is over, regulations around telehealth are changing and providers need a strategy to navigate the transition. The following guidelines provide a quick overview of what’s changing and what’s staying the same.

What isn’t Changing

Temporary telehealth services added during the PHE will continue through the end of 2023. This includes providing telehealth services to patients in any geographic area and at any site, including the patient’s home. These telehealth services can consist of audio and video or audio-only communications technology. This will continue through December 31, 2024, as laid out in the Consolidated Appropriation Act of 2023 (CAA).1

Note that services included on the Medicare Telehealth Services List must be furnished using, at a minimum, audio and video equipment permitting two-way, real-time, interactive patient-provider communication.

What is Changing

The following changes went into effect on May 11th, 2023. Providers who have yet to make these changes should do so as quickly as possible to maintain compliance.

All telehealth platforms must be HIPAA compliant. The use of Skype, FaceTime, Google Hangouts, etc., for telehealth encounters will expire when the PHE ends

Practitioners will be required to resume reporting their home addresses on the Medicare enrollment form.

Prescribers are required to conduct an in-person visit before administering controlled substances. Opioid use disorder (OUD) patients who begin treatment via telemedicine must see a provider in person to renew their prescription beyond 30 days.

Only established patients will be able to receive remote video evaluations and virtual check-in services (G2012, G2252, G2010, G2251 for virtual check-ins and 99421-99423 for digital portal visits. These are not applicable for modifier 95). All new patients will be required to have an initial in-person visit.

The PHE-related change in verbal patient consent requirements from before each visit to annually has become permanent.

This change will expire at the end of the calendar year. Incident-to services via virtual supervision will no longer be allowed after Dec. 31, 2023.

What is Extended Through 2024?

Several CAA telehealth extensions will continue through 2024. These include the following:

  • Some non-behavioral services (CPT® 99441-99443) can be delivered using audio-only communication through Dec 31, 2024. Modifier 95 is applicable in these cases. Note that new patients or patients within post-operative periods are not included.
  • Behavioral and mental health services (CPT® 90785-90840) are now permanently added to the Medicare Telehealth Services List. These may be provided using audio-only equipment through Dec. 31, 2024. Note that the FQ modifier needs to be used for behavioral health services audio-only services (reference the CMS audio-only list for BH). However, audio-only visits will be allowed if someone is unable to use both audio and video. Providers should also note that to use the FR modifier for audio/video behavioral health services, physician presence is required.
  • The exclusion of the in-person visit requirement within six months of an initial behavioral/mental telehealth service, and annually thereafter, will continue through December 31, 2024.
  • Hospice care recertification can be completed via telehealth with audio/video.
  • Use of the modifier 95 (audio/video) synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system remains in effect until December 31, 2024, unless otherwise instructed. Note that this modifier may only be appended to the services listed in the Appendix P of CPT® (Appendix P is the list of CPT® codes for services typically performed face-to-face but that may be rendered via a real-time interactive audio and video system).
  • The use of modifier 93 (audio only) synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system will remain in effect until December 31, 2024. Note that modifier 93 may only be appended to the services listed in the Appendix T of CPT®.
  • Providers must obtain consent prior to a service via telemedicine from the beneficiary receiving services or from their legal guardian. Providers must also allow beneficiaries to elect to return to in-person services at any time.
  • Services rendered via telemedicine may not be recorded without the beneficiary’s consent.
  • Beneficiaries may elect not to receive services via telemedicine at any time.
  • Providers must continue fully documenting services rendered, including the type of telecommunication provided. If audio-only, providers must document the reason audio/video technology could not be used.
  • Providers should be careful not to allow the convenience of the phone call (audio only) to override the medical appropriateness of an in-person and/or audio and video encounter. There is a time for audio-only, but those should be rare.

Adapting to Change

The healthcare industry is still transitioning to what will become our “new normal.” That means providers need to be both flexible and prepared for ongoing change. Partnering with revenue cycle experts can help providers achieve both flexibility and preparedness. The right partner can help streamline revenue cycle processes, reduce errors that lead to denials and write-offs, increase collections, and enhance the patient experience—all amid unforeseen changes. In times of uncertainty, partners can deliver both peace of mind and a healthier bottom line.

information icon
Let’s Talk
Share This Page