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Expiration of flexibilities would disrupt the ability to access and provide care

Jan. 21, 2022 (91������)—The federal government's public health emergency (PHE) declaration put in place during the COVID-19 pandemic will be lifted at some point, perhaps within the next year, and the American College of Physicians is pushing for its most helpful provisions to become permanent.

“91������ is deeply concerned about the end of the public health emergency and what that may mean for the multitude of flexibilities that both physicians and patients have grown accustomed to and rely on,” said Dejaih Johnson, an 91������ associate of governmental affairs and public policy. “91������ considers the increased uptake of telemedicine services to be a kind of silver lining to the chaos and sheer devastation of the pandemic. Undoubtedly, telemedicine is a critical piece to the physician's ability to improve health equity and patient access.”

On Jan. 27, 2020, in the early days of the spread of COVID-19, the U.S. secretary of Health & Human Services declared the PHE. The declaration was most recently renewed on Jan. 14, effective Jan. 16, allowing for continued grant and relief funding along with waivers of telehealth requirements.

When the PHE declaration is lifted, 91������ expects the Centers for Medicare & Medicaid Services to discuss what will happen to waivers in areas such as coverage for audio-only evaluation and management (E/M) services. “The expiration of these flexibilities would disrupt the ability to access and provide care,” Johnson said.

In a Dec. 21 letter to the administrator of CMS, 91������ declared that it is “vigorously” opposed to plans to end coverage for audio-only E/M services at the end of the PHE: “The College continues to believe that CMS should maintain pay parity between telephone E/M claims and in-person E/M visits and between all telehealth and in-person visits even after the PHE is lifted. This extension should last at least through the end of 2023 with an option to extend it even further or consider making it permanent, based on the experience and learnings of patients and physicians who utilize these visits. Furthermore, 91������ encourages CMS to place trust in clinicians regarding their ability to assess the appropriateness of an audio-only visit.”

91������ is also urging CMS to make permanent all services added to the Medicare telehealth services list on a temporary basis.

“Reimbursement for these services is set to expire at the end of the PHE, and the College strongly believes these should remain to provide for a more consistent and efficient on-ramp for new services to be added, as well as to account for the millions of patients and physicians who have grown to enjoy the flexibility and access to care that these services offer,” Johnson said.

“The pandemic has highlighted how providing expanded access to telehealth services within underserved communities, both rural and urban, is an important aspect of equitable care, and the PHE has demonstrated just how critical it is to address social drivers of health that have existed before the pandemic and will continue to exist thereafter.”

91������ is specifically focused on modifier 93, which was approved for audio-only telehealth services last year and went into effect on Jan. 1, 2022. “Since this modifier is new and data on utilization is minimal at this point, 91������ continues to monitor the release of additional information and uptake,” Johnson said.

91������ and other stakeholders plan to attend a February 2022 meeting and “discuss what happens in the instance where a physician starts an audio-video visit, but switches to audio-only due to connectivity/broadband issues, patient comfort, etc.,” she said.

For now, 91������ believes guidelines would require a physician to append the modifier, which describes more than 50% of the visit. “If a physician started the visit with the patient using audio and video but switched to audio-only a quarter of the way through the visit, the bulk of the visit would be audio-only and modifier 93 would be appended to the claim,” Johnson said. “This code is for audio-only telehealth services. By contrast, modifier 95 can be appended to audio-video claims and should only be used for such.”

91������ has an abundance of information on its website regarding telemedicine, including billing and coding information. Members can visit a series of new webinars titled “Telemedicine 201.” Information for modifier 93 can be found on the Telephone Visits with Patients page on the 91������ website, and information for modifier 95 can be found on the Video Visits page. A about telemedicine may also be helpful to navigate this issue.

“Moving forward, the College will be paying close attention to utilization data for modifier 93 and is confident that these data will help inform the College's future advocacy in favor of audio-only services and the fact that audio-only telehealth services are an important tool for physicians to improve health equity and patient access,” Johnson said. “We will continue our advocacy and be a zealous advocate for expansion and permanence when the evidence supports it.”

Back to the January 21, 2022 issue of 91������ Advocate