In November 2021, the Centers for Medicare and Medicaid Services (“CMS”) issued the Physician Fee Schedule Final Rule (“Final Rule”) which includes several telehealth policy updates that will go into effect in calendar year 2022.¹  As a result of the COVID-19 public health emergency (“PHE”),  CMS expanded the availability of telehealth through the use of waivers and flexibilities to ensure continued access to care. While CMS continues to evaluate the impact of the temporary pandemic-driven policy changes, the following key takeaways from the Final Rule offer insight into CMS’ strategy regarding current and future telehealth policy.

• Telehealth Services List: CMS declined to permanently add any of the temporary Category 3 services to the Medicare Telehealth Services List, citing insufficient evidence to conclude that the services meet the criteria as either a Category 1 or Category 2 service.² However, CMS did note that Category 3 services will remain on the telehealth services list until the end of calendar year 2023.³ The extension is intended to allow additional time for stakeholders to collect, analyze, and submit data supporting the addition of the service as a Category 1 or Category 2 service.⁴

• Behavioral Health: The Final Rule authorizes Medicare payment for telehealth services furnished “for purposes of diagnosis, evaluation or treatment of a mental health disorder” on a permanent basis (even after the PHE ends).⁵ For additional information related to Medicare Telehealth behavioral health services read Polsinelli’s e-alert here.

• RHC and FQHC Telehealth Services: CMS also expanded access to behavioral health services by confirming in the Final Rule that Medicare will pay for mental health visits furnished by Rural Health Clinics (“RHC”) and Federally Qualified Health Centers (“FQHC”) via real-time, telecommunications technology in the same way they are reimbursed for these services when furnished in-person.⁶

• Extended Virtual Check-In: In 2021, CMS established, on an interim basis, additional coding and payment for an extended virtual check-in, which can include audio-only communications.⁷ CMS confirms in the Final Rule the permanent adoption of HCPCS Code G2252 (Brief communication technology-based service, e.g., virtual check-in service, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11–20 minutes of medical discussion.) CMS notes that this extended virtual check-in describes situations in which a patient’s problem is unlikely to warrant an in-person visit but the needs of the patient require additional assessment time.⁸ CMS has previously noted that it will not pay for audio-only E/M visits post PHE, however, HCPCS Code G2252 can be furnished using any form of synchronous communications technology, including audio-only.

• Medical Nutrition Therapy & Diabetes Self-Management Training Services: Medicare covers Medical Nutrition Therapy (MNT) and diabetes self-management training (DSMT) services when performed by registered dietitians and nutrition professionals pursuant to a referral from a physician. The Final Rule made several clarifications to the rules related to these services, including specifying that MNT and DSMT services may be provided as telehealth services when registered dietitians or nutrition professionals act as distant site providers.⁹ 

¹  86 Fed. Reg. 64996 (Nov. 19, 2021) available here
²  When considering whether to add services to the Medicare Telehealth Services List,  CMS places proposed services into one of three categories. Category 1 services are services that are similar to services that are already on the telehealth list, such as professional consultations or office psychiatry services. Category 2 services are services that do not meet Category 1 criteria, but there is evidence (including clinical studies and published peer review articles) demonstrating that the service furnished by telehealth improves the diagnosis or treatment of an illness or injury.  In 2021, CMS created a third category to add services to the telehealth list on a temporary basis that are likely to provide a clinical benefit when furnished via telehealth, but there is not currently sufficient evidence to include the services in either Category 1 or 2. Category 3 services ultimately must meet the requirements under Category 1 or 2 to be permanently added to the telehealth list.
³  It is possible that this timeline could be extended, but CMS stated that further extensions were beyond the scope of the Final Rule at this time. 
⁴  86 Fed. Reg. 64996, 65047-65054 (Nov. 19, 2021)
⁵  Telehealth services must meet the conditions in 42 C.F.R. 414.65 and 410.78, as well as state requirements, to lawfully seek Medicare reimbursement.
⁶  86 Fed. Reg. 65209-65210 (Nov. 19, 2021)
⁷  85 Fed. Reg. 84536
⁸  86 Fed. Reg. at 65064
⁹  86 Fed. Reg. at 65194-65197