New PFS Rule Includes Telehealth Payment, Address Reporting Wins

November 03, 2023 - Though the newly released 2024 Physician Fee Schedule (PFS) final rule did not bring good news for all in the healthcare industry, telehealth proponents garnered some critical wins.

Effective on or after January 1, 2024, the PFS final rule solidified several telehealth policies, including paying telehealth providers the non-facility rate for telehealth services.

The calendar year (CY) 2024 PFS will reimburse telehealth services provided to people in their homes at the non-facility PFS rate “to protect access to mental health and other telehealth services by aligning with telehealth-related flexibilities that were extended via the CAA, 2023 [Consolidated Appropriations Act, 2023].”

This move contradicts recommendations made by the Medicare Payment Advisory Commission (MedPAC) earlier this year. MedPAC recommended that the Centers for Medicare and Medicaid Services (CMS) "resume paying the lower, facility rate for telehealth services as soon as practicable after the PHE [public health emergency]."

PFS payments differ depending on whether they are provided in a facility setting, like a hospital or skilled nursing facility, or a non-facility setting, such as a freestanding clinician's office. Before the pandemic, CMS paid clinicians providing telehealth visits the lower facility-based payment rate instead of higher non-facility rates regardless of where they were located. The agency changed the policy during the pandemic to take the clinician's location into account for both in-person and telehealth services. 

Some trade associations, like the AMGA representing 400 medical groups and health systems, applauded the move.  

“AMGA strongly endorses CMS’ decision to finalize a telehealth payment policy that treats telehealth care as equivalent to in-office care,” the association said in an emailed statement. “Today’s rule builds on the lessons learned from the COVID-19 public health emergency, which demonstrated how vital telehealth care is to providing access to high-quality healthcare. The cost of treating patients through telehealth does not differ from an in-person visit, and AMGA is pleased that CMS’ 2024 final rule reflects this.”

The final rule also allows providers who offer telehealth services from their homes to list their practice address instead of their home address on their Medicare enrollment forms through the end of 2024.

Recently, several professional organizations, including the American Hospital Association (AHA) and the American Telemedicine Association (ATA), wrote letters to CMS detailing the potential privacy and security risks of requiring healthcare providers to report their home addresses.

“Clinicians, their loved ones, and other stakeholders can breathe a sigh of relief – at least until the end of 2024 – that Medicare providers will not be required to publicly report their home address as their practice location. This reprieve will help to maintain the safety and privacy of physicians and removes a significant roadblock to access to care,” said Kyle Zebley, senior vice president of public policy at the ATA and executive director of its advocacy arm, ATA Action, in an emailed statement.

Additionally, the rule finalized the implementation of several provisions included in the CAA, 2023.

It solidified provisions to remove geographic restrictions on originating sites for telehealth services, expand the types of telehealth practitioners to include qualified occupational therapists, physical therapists, speech-language pathologists, and audiologists, and delay the requirement for an in-person visit with a healthcare practitioner in the six months before a telemental health visit.

Under the 2024 PFS, rural health clinics and federally qualified health centers will continue to receive payment for telehealth services.

In addition, health and well-being coaching services will be temporarily added to the Medicare Telehealth Services List for CY 2024, and Social Determinants of Health Risk Assessments will be added permanently.

Further, CMS is finalizing the proposal to allow all diabetes self-management training services to be provided via telehealth and enable teaching physicians to be present using audio/video real-time communications technology when a resident furnishes Medicare telehealth services through the end of 2024.

“With nearly all of the flexibilities established during the COVID-19 public health emergency (PHE) extended until the end of 2024, we can expect a telehealth policy “Super Bowl” at the end of next year,” Zebley said. “We have the unprecedented opportunity to impact transformative changes to how healthcare is delivered.”