CMS Proposes to Cut Audio-Only Telehealth Coverage

In a move expected to anger virtual care advocates, the Centers for Medicare & Medicaid Services has proposed dropping Medicare coverage for audio-only telehealth services, including telephone calls, in its 2023 Physician Fee Schedule. The proposed action would take place 151 days after the end of the public health emergency.

The Centers for Medicare & Medicaid Services has proposed dropping Medicare coverage for audio-only telehealth services once the Covid-19 public health emergency is over.

The proposal imperils a service that had become popular during the pandemic, when health systems shifted in-person care to virtual channels to cut down on hospital traffic and reduce the spread of the virus. Thanks to federal and state waivers tied to the pandemic, healthcare providers were allowed to connect with patients on a telephone or other non-video platform for some healthcare services and be reimbursed for those services.

In its proposed 2023 Physician Fee Schedule (PFS), however, CMS aims to eliminate separate Medicare coverage for those services, except for some behavioral health services. That coverage, found in CPT codes 99441-99443, would end 151 days after the end of the PHE, which is expected to take place next year.

The decision won’t sit well with healthcare providers and consumers who see the telephone as a vital channel for healthcare services, especially in rural areas where access to audio-visual telemedicine is limited or even non-existent. Telehealth advocates have been lobbying Congress – and several bills have been introduced – to make audio-only telehealth coverage permanent.

The proposal was highlighted in a blog penned by Foley & Lardner attorneys Nathaniel Lacktman, who chairs the Telemedicine & Digital Health Industry Team and serves on the American Telemedicine Association's Board of Directors; Thomas Ferrante and Rachel Goodman.

"With the exception of certain telemental health services, CMS stated two-way interactive audio-video telecommunications technology will continue to be the Medicare requirement for telehealth services following the PHE," the three attorneys wrote as part of an analysis of all telehealth coverage changes in the proposed 2023 PFS. "This is because Section 1834(m)(2)(A) of the Social Security Act requires telehealth services be analogous to in-person care by being capable of serving as a substitute for the face-to-face encounter."

"In CMS' own language, 'We believe that the statute requires that telehealth services be so analogous to in-person care such that the telehealth service is essentially a substitute for a face-to-face encounter,'" the post continued. "As audio-only telephone is inherently non-face-to-face, CMS determined, that modality fails to meet the statutory standard."

Some states and payers have changed their telehealth guidelines to enable coverage for audio-only telehealth, while others have rolled back those freedoms. Opponents say the telephone isn't a good channel for establishing a doctor-patient relationship or conducting healthcare.

The American Medical Association, meanwhile, has come out in support of permanent coverage.

"Payment for audio-only visits has been a lifeline for patients during the COVID-19 PHE," AMA President James Madara, MD, said in a January 28 letter to Acting CMS Administrator Elizabeth Richter. "The need for these services to be available will not diminish when the PHE ends, and the AMA strongly urges CMS to continue separate payment for the CPT codes in the future."

"While not a high percentage of visits, even during this PHE, access to audio-only services is critical for patients who do not have access to audio-video telehealth services," the letter continued. "Discontinuing payment for these services would exacerbate inequities in healthcare, particularly for those who lack access to audiovideo capable devices such as seniors in minority communities that have been devastated by COVID-19."

As the changes are part of a proposed rule, telehealth advocates point out there is still time to submit comments to CMS. The agency will accept those comments up until 5 p.m. ET on September 6.