| CMS Releases CY 2025 Physician Fee Schedule with Telehealth Policy Updates and Key Modifications |
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On November 1, 2024, the Centers for Medicare and Medicaid Services (CMS) released the Final Calendar Year (CY) 2025 Physician Fee Schedule (PFS), outlining important Medicare policy updates for the coming year. As in previous years, the PFS contains multiple proposals affecting telehealth policy. Many temporary federal telehealth waivers in Medicare are set to expire this year, and their extension would require congressional action. However, CMS has made adjustments within its authority to mitigate the effects of these expirations if Congress does not act to extend statutory flexibilities further.
For those interested in further detail, CCHP has released a fact sheet with specific page references to the unpublished version of the PFS, outlining telehealth-specific proposals and updates in depth.
Below are some of the major takeaways CCHP has identified:
CMS has once again addressed the use of audio-only technology within telehealth services. Since 2022, audio-only was permitted under permanent policy only for mental and behavioral health under the term “interactive telecommunication system.” However, the CY 2025 PFS permanently redefines “interactive telecommunication system” to allow audio-only services for any telehealth visit, provided that both audio and video are technically possible at the practitioner’s site, but the patient either cannot use or declines video technology. This change, effective regardless of waiver extensions, marks a major shift toward flexibility in telehealth delivery. While this update allows broader use of audio-only in telehealth, other limitations remain in effect. CMS specifies that the patient’s home can only serve as an originating site under permanent policies when related to mental health, substance use disorder services, or specific clinical assessments, such as ESRD-related evaluations. To streamline claims for these services, practitioners should use modifier “93” for general audio-only services or “FQ” in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
Each year, CMS opens the public comment period to allow suggestions for new codes on the telehealth services list. For 2025, CMS has reviewed submitted codes and used its recently introduced five-step process to determine each code’s eligibility for either provisional or permanent inclusion. In this year’s assessment, CMS has retained the provisional status of several Therapy, Audiology, and Speech Language Pathology codes that were at risk of removal post-expiration of waivers. CMS will continue evaluating these codes in a future comprehensive review. Additional codes were also added for PrEP for HIV, caregiver training and safety planning interventions. Reference Table 12 in the Final 2025 PFS to see the list of codes and whether they have a permanent or provisional status.
Additional Finalized Changes
- CPT Code Updates: CMS will replace G2012 with the new CPT code 98016, aligning more closely with AMA’s recent coding updates. CPT codes 99441, 99442, and 99443 will return to a bundled status post-waiver expiration.
- Frequency Limitations Suspended: CMS will continue suspending frequency limitations for subsequent inpatient visits (99231-99233), subsequent nursing facility visits (99307-99310), and critical care consults (G0508-G0509) through 2025.
- Direct Supervision via Live Video: CMS has extended allowances for meeting direct supervision requirements using real-time video until December 31, 2025. This includes supervision of auxiliary personnel, teaching residents in telehealth settings, and certain FQHC and RHC telehealth services.
- Telehealth Services for FQHCs & RHCs: Non-behavioral telehealth services in FQHCs and RHCs will continue under temporary policy using code G2025, which reimburses telehealth services at an average weighted rate. CMS notes that this will help ensure continuation of services if the current telehealth waivers do expire on December 31, 2024.
- Opioid Treatment Programs (OTPs): OTPs can conduct periodic assessments via audio-only if live video is unavailable, provided that specific requirements are met. Additionally, the OTP intake add-on code (G2076) can be billed via live video for methadone treatment initiation.
- Other Provisions:
- The originating site fee has increased to $31.01.
- CMS clarified that services billed with POS 10 (telehealth provided in the home) will be reimbursed at the non-facility rate.
- Distant site providers may continue listing their practice location instead of their home address if delivering telehealth services.
- Advanced Primary Care Management codes for FQHCs and RHCs, based on existing communication technology-based services (CTBS), will be reimbursed separately from the PPS/AIR rate.
 The Final CY 2025 PFS highlights CMS's commitment to maintaining flexibility within Medicare telehealth policies where possible. While CMS lacks the authority to extend waivers beyond the December 31, 2024 deadline, this rule aims to mitigate potential impacts, especially for FQHCs, RHCs, and OTPs, who may continue telehealth services without waiting for congressional action.
CCHP has created a Fact Sheet, which is now available, outlining all telehealth changes finalized for 2025.
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Expanded Flexibility for Home Health Telehealth Reporting During Inpatient Stays |
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On October 10, 2024, the Centers for Medicare and Medicaid Services (CMS) released a Medicare Learning Network (MLN) Update allowing specific telehealth services by home health agencies (HHAs) during inpatient stays, which brings new flexibility to telehealth reporting requirements for home health care.
Key takeaways for Home Health (HH) Providers, are reflected in an update to Section 30.9 of the Medicare Claims Processing Manual, Chapter 10. Here’s what billing teams need to know:
- Clarification around duplicate billing: CMS clarified that patients can’t be inpatients in a hospital or skilled nursing facility (SNF) and receive HH care simultaneously. They will reject the HH claim if providers bill an HH Prospective Payment System (PPS) claim with dates of service that fall within the dates of an inpatient, SNF, or swing bed claim (not including the dates of admission and discharge and the dates of any leave of absence). Providers can submit a new claim removing any dates of service within the inpatient stay that were billed in error.
- New Exception to Reporting Telehealth Services: Home health agencies and suppliers can, however, now report telehealth interactions with caregivers for patients during inpatient stays, using HCPCS codes G0320, G0321, and G0322. These codes reflect non-payable reporting for services and therefore do not trigger the issue of duplicate payments.
For more information, see the MLN Update and Chapter 10 of the Medicare Claims Processing Manual. |
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CMS Updates Medicare Benefit Policy for FQHCs and RHCs: New Requirements for RPM, RTM, CHI, and PIN Services
In October the Centers for Medicare and Medicaid Services (CMS) updated their Medicare Benefit Policy Manual with new information specifically for federally qualified health centers (FQHCs) and rural health clinics (RHCs) regarding remote patient monitoring (RPM) services, remote therapeutic monitoring (RTM) services, community health integration (CHI) Services, Principial Illness Navigation (PIN) Services, and PIN-Peer Support (PS) Services. The updates clarified specific payment requirements FQHCs and RHCs must adhere to for these services and include the following:
- RPM/RTM Services: Effective January 1, 2024, RHCs and FQHCs are paid for RPM/RTM services when a minimum of 20 minutes of qualifying non-face-to-face RPM services are furnished during a calendar month. RHCs and FQHCs are also paid for the initial set-up and patient education on use of the equipment that stores the physiologic data for RPM/RTM services.
- CHI/PIN Services: Effective January 1, 2024, RHCs and FQHCs are paid for CHI/PIN services when a minimum of 60 minutes of qualifying non-face-to-face CHI services are furnished during a calendar month.
- PIN-Peer Support Services: Effective January 1, 2024, RHCs and FQHCs are paid for PIN-PS services when a minimum of 60 minutes of qualifying PIN-PS services are furnished during a calendar month.
Additionally, the chronic care management (CCM) services section was also revised to incorporate new requirements for FQHCs/RHCs. Under the newly updated CCM Services policy, a separately billable initiating visit with an RHC/FQHC primary care practitioner—such as a physician, nurse practitioner, physician assistant, or certified nurse-midwife—is required before starting care management services. This visit, which can be an Evaluation and Management (E/M), Annual Wellness Visit (AWV), or Initial Preventive Physical Examination (IPPE), must take place within a year before beginning care management. Beneficiary consent for care management can be obtained by auxiliary staff under general supervision or by the billing practitioner, either in written or verbal form, and documented in the patient’s medical record. The documentation must confirm that the patient has been informed about the availability of care management services, the need to consult specialists as appropriate, potential cost-sharing for in-person and non-face-to-face services, the exclusivity of one provider for care management services per month, and the patient’s right to discontinue services at any time at the end of a month. To review all the Medicare policies around telehealth, CCM, RPM, RTM, CHI and PIN services, see the full Medicare Benefit Policy Manual. |
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Key Insights from New IMLCC Reports on Licensing, Physician Impact, and Service Expansion
Recently, the Interstate Medical Licensure Compact Commission (IMLCC) has updated the alerts section of their website to feature three new insightful reports on data they have collected on both their licensing process and physicians. Each report, the IMLCC states, highlights the essential efforts of the IMLCC and its member boards to improve access to quality healthcare by streamlining the licensing process for physicians across state lines. The reports include the following:
- Fiscal Year 2024 Annual Report – The IMLCC's annual report for its fiscal year (July 2023 to June 2024) showcases a successful year with significant growth and achievements. The Compact now includes 42 member jurisdictions—40 states, the Territory of Guam, and the District of Columbia—and expects legislative consideration in at least five additional states. In April 2024, the IMLCC celebrated its 7th year and issued its 100,000th license. Noteworthy metrics for the fiscal year include 23,829 applications processed, 38,096 licenses issued, 32,146 licenses renewed, and 84,281 financial transactions, with over $28 million in fees directed to member boards. Despite a substantial rise in applications (30-50%), processing times have continued to improve. Additionally, 46 disciplinary actions were taken in FY2024, with all affected member boards promptly notified. A significant joint investigation, which included ten member boards is also mentioned in the report.
- New State License Volume Report - 2019 to 2023 – This report examines application volumes across states to reveal the IMLCC’s impact on licensing. States with the highest percentage of initial licenses issued through the Compact include Montana (99%), Nebraska (76%), and Vermont’s Board of Osteopathic Physicians and Surgeons (68%). Lower percentages were seen in Connecticut (3%), Ohio (10%), and Texas (18%). Across all member states, 39% of initial licenses were issued through the IMLCC pathway, illustrating the Compact’s growing role in supporting interstate medical practice.
- Physician Survey Data Infographic - 2022 to 2024 – This infographic report summarizes feedback from 6,674 physicians on 19,329 renewal applications between January 2022 and September 2024. When physicians were asked to select a practice area, the results indicate that 49.18% of respondents selected direct patient care, while 41.29% said they worked primarily in telemedicine, with smaller portions reporting their primary work was in research (1.22%), teaching (1.75%), and administrative roles (6.55%). When asked about serving rural or underserved communities, only 4.25% reported doing so full-time, while 45.80% of respondents serve these communities less than 25% of the time. Notably, 94% of physicians found the IMLCC licensing process beneficial, either agreeing or strongly agreeing with a question regarding its value.
For more information on the IMLC, visit the IMLC website to access all of the reports, see the states participating and application requirements. |
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Another Extension on DEA Telehealth Prescribing Rules for Controlled Substances in White House Review
The U.S. Drug Enforcement Administration (DEA) is expected to extend temporary rules that allow providers to prescribe controlled substances via telehealth without requiring an in-person visit, as the current extension ends December 31, 2024. The DEA recently submitted a new rule titled “Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” for White House review. This is the second attempt by the DEA to establish permanent telehealth prescribing rules, but concerns and feedback from stakeholders have led to another temporary extension instead. Earlier this year, the DEA drafted a set of permanent rules with substantial limitations (as reported by news outlets, though it was never released publicly), but it stalled due to concerns from the U.S. Department of Health and Human Services (HHS). Last year, a similar proposal generated nearly 40,000 public comments, leading to the ongoing temporary extension. CCHP continues to monitor this issue closely and will provide updates as new developments unfold. |
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CMS Clarifies Billing Requirements for Telehealth Medicare Diabetes Self-Management Training (DSMT)
The Centers for Medicare and Medicaid Services (CMS) has issued an update on billing requirements in their Medicare Learning Network (MLN) Fact Sheet for Medicare Diabetes Self-Management Training (DSMT), specifically regarding telehealth services. The factsheet states that providers may deliver DSMT as a telehealth service when a registered dietitian, nutrition professional, physician, nurse practitioner (NP), physician assistant (PA), or clinical nurse specialist (CNS) serves as the distant site practitioner. These practitioners can bill and receive payment for DSMT services when they:
- Act on behalf of other qualified personnel who deliver the DSMT services within an authorized DSMT entity.
- Provide injection training for insulin-dependent patients through interactive telehealth technology, as long as this training is part of the patient’s DSMT plan of care.
CMS emphasizes that telehealth-based DSMT injection training must align with recognized clinical standards, guidelines, or best practices to ensure patient safety and efficacy. This clarification allows providers to better support patients in managing diabetes through accessible telehealth options, while meeting Medicare billing requirements. For more information, refer to the full CMS DSMT Fact Sheet. |
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Telehealth Proves as Effective as In-Person Care for Early Palliative Treatment in Advanced Lung Cancer
A recent study published in JAMA titled “Telehealth vs In-Person Early Palliative Care for Patients with Advanced Lung Cancer” has shown that telehealth can be as effective as in-person care for early palliative treatment in patients with advanced non–small cell lung cancer (NSCLC). This multisite randomized clinical trial, conducted across 22 U.S. cancer centers from June 14, 2018, to May 4, 2023, included 1,250 patients and assessed the impact of secure video versus in-person palliative care on patient quality of life by administering a questionnaire to participants. Results after 24 weeks indicated equivalent quality-of-life outcomes between video and in-person care groups, with patients receiving video-based care reporting similar scores to those meeting in-person. Although caregiver participation was lower for virtual visits, there was no significant difference in caregiver quality of life or in other key measures such as patient coping, mood, or satisfaction with care. This study highlights the potential for telehealth to expand access to essential palliative care services for patients with advanced cancer. For more information, see the full study article (purchase required).
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What’s New at CCHP this Month?
CCHP is continually working to create helpful informational content to keep those interested in telehealth and related policies up to date via our policy finder, informational factsheets, webinars, reports and email blasts. As you may already be aware, CCHP regularly distributes a single topic specific email every Tuesday titled “Telehealth Tuesdays”. If you are not yet on our distribution list to receive these emails, and would like to be added, you can do so by registering on the CCHP website.
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Quick links to recently curated and featured insightful topics in our Telehealth Tuesday email blasts:
NOVEMBER 5, 2024: Senators Question Pharmaceutical Companies’ Use of Telehealth Platforms covering a request by four US Senators to Eli Lilly and Pfizer regarding their recent launch of telehealth direct-to-consumer platforms.
OCTOBER 29, 2024: Trending Telehealth Research – HHS Research Recaps and Highlights covering resources for patients and providers looking to utilize services via telehealth housed on the U.S. Department of Health and Human Services (HHS) telehealth website. The website also offers funding opportunities related to telehealth and broadband programs, as well as a research section.
OCTOBER 22, 2024: Recent Reports Highlight Policy Recommendations Related to Remote Patient Monitoring covering the U.S. Department of Health and Human Services Office of Inspector General (OIG)’s new report regarding remote patient monitoring (RPM), which describes existing federal coverage policies and recent utilization rates, as well as recommending additional oversight of the telehealth modality’s use within the Medicare program.
OCTOBER 15, 2024: Telehealth and Court Cases Continued: Recent Ruling Additionally Highlights Legal Implications Relevant to Telehealth Policy covering a recent U.S. Court of Appeals ruling in Hines v. Pardue which favored Dr. Ronald Hines, finding Texas’ in-person exam requirement for veterinarian services before giving online medical advice violated the First Amendment by improperly regulating speech. This decision raises important questions for telehealth policy with potentially wide-reaching implications.
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In addition to our featured topics in CCHP’s Telehealth Tuesday emails we have also released the following valuable resources:
- Last month, the California Telehealth Policy Coalition, which is convened by CCHP, hosted their legislative briefing to review policy developments over the last year and discuss remaining gaps and opportunities for advancing access to telehealth in California. During this briefing, a panel of experts and stakeholders discussed topics including asynchronous telehealth policies, licensure, broadband and artificial intelligence (AI). The video of the legislative briefing is now available.
- CCHP conducted a webinar on October 3, 2024, which is now available for viewing, covering two pivotal cases—MacDonald et al v. Sabando (New Jersey, December 2023) and McBride et al v. Hawkins (California, May 2024)—that challenge the constitutionality of requiring providers licensed in one state to obtain a separate license for telehealth interactions with patients in another state. The session explored the impact of existing licensure laws, the potential implications if these cases succeed, and the broader consequences for telehealth regulations.
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FEDERAL LEGISLATION
Maternal and Infant Syphilis Prevention Act
S 5203 (Sen. Heinrich D-NM) - Requires the Secretary to issue guidance to state Medicaid programs, to include strategies for integrating telehealth services and training for providers and patients on the use of telehealth, specifically in respect to treating congenital syphilis. (Status: 9/25/24 – Introduced in Senate and referred to Senate Committee on Health, Education, Labor and Pensions)
Telehealth Enhancement for Mental Health Act (TELEMH) of 2024
HR 7858 (Rep. James R-MI) – Requires that not later than January 1, 2026, the Secretary shall establish requirements to include a code or modifier, as determined appropriate by the Secretary, in the case of claims for telehealth services that are billed incident to a physician’s or practitioner’s professional service. (Status: 9/18/24 - Received in the Senate and Read twice and referred to the Committee on Finance)
Transparent Telehealth Bills Act of 2024
HR 9457 (Rep. Bean R-FL) - Amends the Employee Retirement Income Security Act to require that in the case of a telehealth service furnished to a participant or beneficiary of a group health plan or group health insurance coverage by a health care provider located at a health care facility, the total amount recognized by such plan or coverage as payment for such service (including any facility fee or other amount that may be billed separately by such facility in relation to such provider’s furnishing of such service) may not exceed the total amount that would have been recognized by such plan or coverage as payment for such service had such provider not been located at such a facility. A report is also required no later than 18 months after the date of enactment on what is known about the use of telehealth under group health plans and individual health insurance coverage. See bill for details. (Status: 9/11/24 - Committee Consideration and Mark-up Session Held. Ordered to be Reported by the Yeas and Nays: 34 - 0.)
Protecting Veteran Access to Telemedicine Services Act of 2024
HR 9324 (Rep. Womack R-AR) - Authorizes certain heath care professionals employed by the Department of Veterans Affairs to deliver, distribute, or dispense to veterans certain controlled medications via telemedicine under certain conditions. See bill for details. (Status: 9/11/24 – Referred to Subcommittee on Health)
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STATE LEGISLATION
ALASKA
SB 75 – Enacts the Audiology and Speech Language Pathology Compact in Alaska, which facilitates the interstate practice of audiology and speech-language pathology through a contractual, legislatively enacted agreement among the member states. (Status: 10/9/24 – Signed into law)
CALIFORNIA
AB 2246 - Amends the definition of health care provider within telehealth statutes to include a qualified autism service paraprofessional. (Status: 8/15/24 – In committee: Held under submission)
NEW JERSEY
S 1067 - Requires the state to implement and maintain culturally affirmative and linguistically appropriate mental health services for individuals that are deaf or hard of hearing; including recruiting, developing, and maintaining an adequate number of certified mental health professionals; and developing and implementing strategies to ensure access to mental health services regardless of geography, which may include the use of telehealth. (Status: 10/28/24 – Passed Senate, Received in the Assembly, Referred to Assembly Appropriations Committee)
NEW HAMPSHIRE
HB 1571 – Requires insurance coverage for glucose monitoring devices for people with diabetes. Additionally, the bill requires the commissioner of the department of health and human services to submit a Title XIX Medicaid state plan amendment to the federal Centers for Medicare and Medicaid Services for the purpose of establishing a Medicaid benefit for diabetes services and supplies. The Medicaid benefit shall include coverage for glucose monitoring devices. (Status: 9/25/24 – Executive Session held on 10/17/24)
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CCHP knows that telehealth policy can be a complicated subject and from time to time questions about policies related to your specific situation may arise. You’re in luck…We’re here for you! Just submit your question via our easy to use contact us form, or send an email to info@cchpca.org
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