Medicare Telehealth Policy Changes are set to reshape the landscape of telehealth services. As the COVID-19 public health emergency ends, Medicare will revert to pre-pandemic policies, imposing stricter rules for telehealth services starting January 1, 2025, unless Congress intervenes.
Key changes include:
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- Geographic Restrictions: Patients must generally live in a health professional shortage area, a rural census track, or a county outside of a metropolitan statistical area to be eligible for Medicare telehealth services.
- Limited Service Expansion: While certain behavioral and mental health services will continue to be covered via telehealth, many other services will revert to pre-pandemic rules.
The Medicare Telehealth Policy Changes have the potential to significantly limit patient access to care, especially for those in rural or underserved areas. Healthcare providers and patients must be aware of these new rules and plan accordingly to mitigate their impact.
Medicare Telehealth Policy Changes 2025
CPT Code Updates:
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- Audio-only Telehealth: CMS will no longer recognize audio-only telephone services (CPT codes 99441-99443) starting in 2025.
- New Telehealth CPT Codes: Most of the new telehealth CPT codes (98000-98015) added for 2025 will not be recognized by Medicare. The only exception is code 98016 for brief virtual check-in encounters.
Telehealth Service Expansion:
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- Permanent Telehealth Services: Certain behavioral and mental health services will be permanently available via telehealth for Medicare patients.
- Direct Supervision: Direct supervision through real-time audio and video telecommunications will continue to be allowed for qualifying services.
Place of Service (POS) Codes:
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- POS Codes 02 and 10: These codes will continue to be used to indicate whether the patient is in their home or not during telehealth services.
- Physician Home Address: Physicians can still use their practice address as the service location for telehealth services performed from home.
Geographic and Location Restrictions:
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- Pre-Pandemic Restrictions: Pre-pandemic geographic and location restrictions for telehealth will be reinstated. This means that Medicare patients must generally live in a health professional shortage area, a rural census track, or a county outside of a metropolitan statistical area to be eligible for telehealth services.
Teaching Physician Telehealth:
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- Temporary Expansion: Teaching physicians can continue to have a virtual presence in all teaching settings for Medicare telehealth services, but only until December 31, 2025.
Congress Holds the Key to Telehealth’s Future
Despite the Medicare Telehealth Policy Changes, there’s still hope for expanded telehealth access in 2025. Congress has the power to address the current geographic restrictions on Medicare telehealth services. However, time is running out.
The Telehealth Modernization Act of 2024, which aims to relax these restrictions, is currently stalled in committee. If Congress fails to act by the end of the year, a significant portion of telehealth encounters could become ineligible for Medicare reimbursement. To advocate for broader telehealth access, please contact your local representative and urge them to support the Telehealth Modernization Act.
Why Are My Telehealth Claims Being Denied?
Telehealth has revolutionized healthcare access and convenience. However, the recent Medicare Telehealth Policy Changes have introduced new complexities in the billing process. Telehealth claim denials often occur due to documentation errors, coding inconsistencies, and payer-specific telehealth policies.
A common pitfall is the improper use of modifiers, such as Modifier 95, which signifies synchronous telehealth services. Without this modifier, claims may be rejected for not meeting telehealth criteria. Similarly, inconsistent coding practices or outdated codes can lead to denials as payers may not recognize these services under their current guidelines.
Payer policies for telehealth vary widely, with some insurers limiting specific services or requiring pre-authorization. Non-adherence to these payer-specific requirements can result in claim denials. Additionally, incomplete documentation – such as missing details about the virtual visit’s location, provider’s credentials, or patient consent – can invalidate a telehealth claim.
To minimize these denials, providers should implement standardized coding and documentation practices tailored to telehealth. Utilizing up-to-date telehealth codes, modifiers, and confirming each payer’s guidelines before billing are essential steps. Partnering with a medical billing company like Allzone can further streamline the process. Allzone can provide specialized training for staff in telehealth billing and coding, ensuring compliance. Verifying eligibility and prior authorization requirements before service delivery can also reduce denials.
Through these proactive measures, providers can improve telehealth claim acceptance rates, leading to faster reimbursement and enhanced access to telehealth for patients.