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CMS Updates Telehealth Rules, Approves Using E/M Code G2211

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CMS Updates Telehealth Rules, Approves Using E/M Code G2211

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Telehealth services

If your practice has been eagerly awaiting word from CMS about how Medicare payments would be calculated in 2024, the wait is over. The agency released its 2024 Physician Fee Schedule Final Rule on November 2, and the provisions include a 3.4% lower conversion factor of $32.7375, updates to the telehealth rules, approval of using new E/M add-on code G2211, new split/shared visit updates and much more.

Check out just a few of the highlights you’ll find in this year’s Final Rule — from telehealth services to E/M and beyond — which take effect January 1, 2024.

Look for Changes to Telehealth Services

First on the list of 2024 changes is CMS’ decision to keep paying for telehealth services using the provider’s practice address even if the provider is using their home as the originating site of the telehealth visit. In addition, CMS will pay the non-facility rate for telehealth visits to patients who are at home during the visit session. These provisions will remain in place through the end of 2024.

In addition, CMS confirmed that marriage and family therapists, occupational therapists, audiologists, physical therapists, speech-language pathologists and mental health counselors will be able to report telehealth services to Medicare in 2024. Plus, CMS is delaying its previous rule requiring an in-person visit six months before providing mental health services via telehealth.

New services that can be performed over telehealth include:

  • New code G0136 (Administration of a standardized, evidence-based Social Determinants of Health Risk Assessment tool, 5-15 minutes)
  • 0591T (Health and Well-Being Coaching face-to-face; individual, initial assessment)
  • 0592T (… individual, follow-up session, at least 30 minutes)
  • 0593T (…group [two or more individuals], at least 30 minutes)

While G0136 has been added to the permanent list of telehealth-allowable codes, 0591T-0593T are on the temporary list.

CMS Will Pay for G2211 With E/M Codes

CMS has also finalized a status change for HCPCS code G2211 (Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. [add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established]).

Practices are expected to use this add-on code during outpatient E/M visits, allowing them to collect “an additional payment, recognizing the inherent costs involved when clinicians are the continuing focal point for all needed services, or are part of ongoing care related to a patient’s single, serious condition or a complex condition,” CMS said.

The agency expects this code to be used on 38% of all office visit codes at first, and says it cannot be reported with an E/M service that has modifier 25 appended to it. In addition, G2211 has been added to the permanent telehealth list effective Jan. 1, 2024.

Check Updates to Split/Shared Visits

You’ll also find updates to CMS’ definition of the “substantive” portion of a split/shared visit, as CMS says it will begin using the AMA’s definition as of January 1.

“For Medicare billing purposes, the ‘substantive portion’ means more than half of the total time spent by the physician or nonphysician practitioner performing the split (or shared) visit, or a substantive part of the medical decision making,” CMS said in its fact sheet about the Fee Schedule.

Coming soon: Want more information about the 2024 Fee Schedule? Keep an eye on Training Leader’s website, where we’ll be posting registration for our online training event covering all the details you need to get paid in 2024.

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