How physical therapists and telehealth are being enabled by CMS to better assist you during the COVID-19 pandemic
CMS guidance now allows physical therapists in private practice to make full use of telehealth with their patients under Medicare Part B. Before this past week they had limited therapists to e-visits and other “communication technology-based services” were allowed; the change now includes PTs among the health care providers permitted to bill for real-time face-to-face services using telehealth. This is retroactive effective date of March 1, 2020 through the end of the emergency declaration.
The CMS document “COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers” states:
Eligible Practitioners: Pursuant to authority granted under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) that broadens the waiver authority under section 1135 of the Social Security Act, the Secretary has authorized additional telehealth waivers. CMS is waiving the requirements of section 1834(m)(4)(E) of the Act and 42 CFR § 410.78 (b)(2) which specify the types of practitioners that may bill for their services when furnished as Medicare telehealth services from the distant site. The waiver of these requirements expands the types of health care professionals that can furnish distant site telehealth services to include all those that are eligible to bill Medicare for their professional services. This allows health care professionals who were previously ineligible to furnish and bill for Medicare telehealth services, including physical therapists, occupational therapists, speech language pathologists, and others, to receive payment for Medicare telehealth services.
As per the American Physical Therapy Association, the basics are:
- Physical therapists in private practice are eligible to bill Medicare for certain services provided via telehealth. [Editor’s Note: APTA is seeking confirmation as to whether services furnished by PTAs via telehealth are eligible for reimbursement.]
- Services that started as of March 1, 2020 and are provided for the duration of the public health emergency are eligible.
- These CPT codes are eligible to be billed: 97161- 97164, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, and 97761.
- Patients may be either new or established.
- These visits are for the same services as would be provided during an in-person visit and are paid at the same rate.
- Patients may be located in any geographic area (not just those designated as rural), and in any health care facility or in their home.
When billing claims for telehealth services provided on or after March 1, 2020, and for the duration of the public health emergency, bill with:
- Place of Service code equal to what it would have been had you furnished the service in person
- Modifier 95, indicating that you did indeed perform the service via telehealth; and use the GP modifier.
When delivering telehealth services, Medicare states that it must be furnished using, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between you and your patient.
If two-way audio and video is not an option, it is important to remember that Medicare allows audio-only telephone assessment and management of services during the public health emergency under CPT codes 98966-98968.
The APTA offers guidance on this:
CMS has waived certain Medicare restrictions on digital communication in light of the COVID-19 pandemic, including “telephone assessment and management services.”
Telephone assessment and management services are services you provide to an established patient, parent, or guardian via real-time phone conversation, and are initiated by the patient. The services are billed using CPT codes 98966, 98967, and 98968.
Although the code descriptor refers to an established patient that you currently are treating under a plan of care, CMS says it is “exercising enforcement discretion” on an interim basis and will not conduct reviews to consider whether these services were furnished to established patients. However, APTA advises you to continue to comply with your state practice act and any other applicable state or local laws, which generally require the PT to have evaluated a patient before providing any recommendations or care.
You cannot bill these codes if the service originates from a related service you provided within the previous seven days, as this service would be considered bundled into that previous service. You also cannot and would not be separately if it results in an assessment or management service or procedure within the next 24 hours or next available appointment.
Billing for this service requires the patient’s consent and must be obtained annually. You may obtain consent at the same time you furnish the service, and consent may be obtained by auxiliary staff under general supervision if not by you. The charge will be subject to coinsurance and deductible.
Include in your documentation of a telephone assessment and management service the following:
- That the patient initiated the call.
- The length of the phone call and the nature of the service and other pertinent information.
- That the patient verbally consented to the service.
- That the call was not related to a service performed and reported within previous seven days.
For Medicare, bill the code once. You cannot bill a second interaction within seven days of any other service provided to the patient. The CPT codes paid under the Medicare Physician Fee Schedule are:
CPT 98966 (Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion)
CPT 98967 (Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion)
CPT 98968 (Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion)
CMS is describing these codes as “sometimes therapy services.” For outpatient claims, the place-of-service code is determined by place where you furnished the service. It does not matter where the corporate address of the billing provider is, nor does it matter what the beneficiaries’ addresses are. For institutional and noninstitutional billing, the GP modifier is required.
During this time it is not necessary to conduct telehealth/telephone calls from your office. The APTA states “During this public health emergency, CMS is allowing physical therapists in private practice (as well as other providers) to furnish telehealth services from their homes without reporting their home address on their Medicare enrollment while continuing to bill from their currently enrolled location.”
Also, during this crisis the HHS office for Civil Rights is relaxing enforcement and waiving penalties for HIPAA violations against clinicians who in good faith use everyday applications that allow for video chats, such as Apple FaceTime and Skype. HHS, the Office of the Inspector General, and the Department of Justice will monitor for health care fraud and abuse, including potential Medicare coronavirus scams. Be aware that you need to adhere to any state laws governing privacy and security of patient data.
In reference to patient cost sharing for services, The Office of the Inspector General states “In response to the unique circumstances resulting from the outbreak of 2019 novel coronavirus (COVID-19) and the Secretary’s January 31, 2020, determination, pursuant to section 319 of the Public Health Service Act, that a public health emergency exists and has existed since January 27, 2020 (COVID-19 Declaration),1 the Office of Inspector General (OIG) issues this Policy Statement to notify physicians and other practitioners that they will not be subject to administrative sanctions for reducing or waiving any cost-sharing obligations Federal health care program beneficiaries may owe for telehealth services furnished consistent with the then applicable coverage and payment rules, subject to the conditions specified herein.”
This is an exciting and positive change that came after tireless advocacy efforts spearheaded by bipartisan lawmaker champions in Congress and physical therapy providers across the nation.