Medicare Behavioral Telehealth Services

CMS is implementing changes from the 2021 Consolidated Appropriations Act to cover the home as the originating site for telehealth services for diagnosis, evaluation, or treatment of a mental health disorder. This expands coverage that was already permitted in the treatment of substance use disorders and co-occurring mental health disorders via telehealth.

The major setback is that for behavioral telehealth services to be covered the first visit must occur in-person six (6) months prior to the first telehealth visit. Even more so, there must be an in-person visit at least every 12 months to continue telehealth services coverage. That is unless the “physician or practitioner and the patient agree that the risks and burdens associated with an in-person service outweigh the benefits associated with furnishing the in-person item or service.” (See amended 42 CFR 410.78). The reason for this decision needs to be documented in the medical record. But how is this communicated to Medicare? Good question, and no clear answer. And, what about Medicare beneficiaries who are currently receiving telehealth? Do they need an in-person visit after Jan 1, 2022? Again, no clear answer.

One positive note is CMS is amending the current definition of “interactive telecommunications system” for telehealth services. The new definition includes audio-only communications technology used for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes under certain circumstances. In addition, CMS is developing a new modifier to identify these services.  CMS has already created a new Place of Service code (POS 10 – home) to report behavioral telehealth services. The usual POS for Medicare is 11-office, confusing as it is used versus “02” for telehealth. Please do not forget to document the beneficiary’s location at the time of service and how you identified them.

One caveat to watch out for – CMS is limiting the use of audio-only services to mental health services furnished by practitioners who can provide two-way, audio/video communications to only when the client is not capable of or does not consent to, the use of two-way, audio/video technology.

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