In the 2022 Physician Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) defines telehealth services that qualify for reimbursement under Medicare through 2023. Those services now include audio-only services under specific circumstances. The patient must:
1. be already “established,”
2. have a mental illness/substance use disorder (SUDs), and
3. be unable or unwilling to use video technology.
The expansion of telehealth to include audio-only services applies only to mental illness/SUDs. In December 2020, Congress approved the Consolidated Appropriations Act (CAA) of 2021, permanently expanded mental health services provided via telehealth by easing geographic and site-of-service restrictions under the Medicare program. The rule is a victory for patients and behavioral professionals.
CMS first proposed in July 2021 the requirement that in-person visits for telehealth, in general, take place every six months for all patients, whether new or established patients, after the initial telehealth encounter. However, in the final rule, the requirement is every 12 months for established patients, with exceptions at the discretion of the treating professional. As required by CAA, there is no exception for new patients. The practitioner must see them in an in-person visit within six months before initiating mental health services via telehealth. In addition, CMS extended definition the patient’s home to include locations beyond the home, such as a homeless shelter or a place a patient needs to go for privacy. The place of service code 02 is used and when the patient is in their home it is 10.
Just as important, clinicians must document the reason for audio-only telehealth in the patient’s record, which includes patient refusal to use videoconferencing, inability to use it, or lack of access. Documentation of client identification, location at the time of service, clinical intervention, progress, medical necessity, start and end times, and all other documentation requirements remain the same.
The on-going argument about the future of audio-only telehealth visits hinges on whether it is effective and, if so, for which patients and situations. Audio-only is not helpful when the patient or clinician feels the need for visual or tactile interaction. The question needs further refinement for behavioral health, as behavioral health patients have traditionally always been “seen” and but rarely touched. Because behavioral problems can run the gambit and are present in all populations, a one-size-fits-all approach to therapeutic interventions would be very short-sighted. The challenge of healthcare technology is that many more people can be helped using various interventions. The promise of healthcare technology can be fulfilled with competency-based care by clinicians, accessibility, and the ability to match the service to the patient’s needs. The informed professional would do well to carefully consider which technology will best serve which patient at various points in the treatment process and that neither patient nor clinician come to rely solely on technology for patient care.
