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Medicare Coverage - 2023

December 16, 2022 11:00 AM | Anonymous


LIST OF CHANGES TO MEDICARE TELEHEALTH SERVICES:

January 1, 2023  (updated November 1, 2022)

Here is some new information on Medical Telemental Health Coverage in 2023.

Postponing the Effective Date of the Telemental Health In-Person Six-Month Rule

In 2020, Congress imposed new conditions on telemental health coverage under Medicare, creating an in-person “exam” requirement alongside coverage of telemental health services when the patient is located at home. Under the rule, Medicare will cover a telehealth service delivered while the patient is located at home if the following conditions are met:

  1. The practitioner conducts an in-person exam of the patient within the six months before the initial telehealth service starting 151 days after the end of the Public Health Emergency.
  2. The telehealth service is furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder (other than for treatment of a diagnosed substance use disorder (SUD) or co-occurring mental health disorder); and
  3. The practitioner conducts at least one in-person service every 12 months of each follow-up telehealth service starting 151 days after the Public Health Emergency.

While there is no requirement that this will apply to commercial insurance, they often follow the Medicare rules. At this time there are no insurers who have said they will require the above rules.

Behavioral Health
A new proposal is being finalized to create a new HCPCS code (G0323) describing General Behavioral Health Integration performed by clinical psychologists (CP) or clinical social workers (CSW). This code is to account for monthly care integration where the mental health services provided by a CP or CSW are serving as the focal point of care integration.

New Telemental Health Codes (Audio Only)
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

The following is a list of behavioral health ICD-10 codes that CMS will cover by audio-only through 2023 OR for 151 days after the end of the Public Health Emergency (PHE). To read the CMS statement go to the link above. Videoconferencing will be covered during the Public Health Emergency for the same codes that are used for in-person and also have 151 days after the end of the Public Health Emergency (PHE). 

There are two new codes – 0362T And 0373T – which are connected to integrated medical and behavioral health care.

Code     Short Descriptor of Telemental Health Codes for Audio-Only CPT Codes   

0362T   Bhv id suprt assmt ea 15 min      Available Through December 31, 2023       

0373T   Adapt bhv tx ea 15 min                Available Through December 31, 2023     

90785   Psytx complex interactive            Available Indefinitely            

90791   Psych diagnostic evaluation        Available Indefinitely   

90832   Psytx w pt 30 minutes                 Available Indefinitely 

90834   Psytx w pt 45 minutes                 Available Indefinitely 

90837   Psytx w pt 60 minutes                 Available Indefinitely 

90838   Psytx w pt w e/m 60 min             Available Indefinitely 

90839   Psytx crisis initial 60 min             Available Indefinitely 

90840   Psytx crisis ea addl 30 min         Available Indefinitely 

90845   Psychoanalysis                           Available Indefinitely 

90846   Family psytx w/o pt 50 min         Available Indefinitely 

90847   Family psytx w/pt 50 min            Available Indefinitely 

90853   Group psychotherapy                 Available Indefinitely 

Please let me know if you have any questions about these changes to Medicare mental health coverage.

Laura Groshong, LICSW, Director, Policy and Practice  
Clinical Social Work Association  
lwgroshong@clinicalsocialworkassociation.org

PO Box 105
Granville, Ohio  43023

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