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CSWA - Medicare Changes to Telemental Health – November, 2021

30 Nov 2021 5:28 PM | CSWA Administrator (Administrator)


As we continue our pandemic journey, changes to the use of telemental health continue to develop.  Two significant ones from CMS have come out this month, one on Place of Service (POS) codes and one on in-person visits required for telemental health treatment.

Place of Service Codes

POS codes are being divided by 1. telemental health provided outside the patient’s home and 2. telemental health provided in the patient’s home.  POS 02, which previously covered both categories, should only be used as of January 1, 2022, for telemental health psychotherapy provided outside the patient’s home.  POS 10, a new code, should be used as of January 1, 2022, for telemental health psychotherapy provided in the patient’s home.  The complete descriptions are as follows:

1. POS 02: Telehealth Provided Other than in Patient’s Home Descriptor: The location where health services and health-related services are provided or received through telecommunication technology. The patient is not located in their home when receiving health services or health-related services through telecommunication technology. 

2. POS 10: Telehealth Provided in Patient’s Home Descriptor: The location where health services and health-related services are provided or received through telecommunication technology. The patient is located in their home when receiving health services or health-related services through telecommunication technology. 

Links for more information can be found at https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set .  These changes may be adopted bycommercial insurance; check with each carrier directly.

Required In-Person Visits with Medicare Patients

I have been tracking this difficult rule for the past year for the Clinical Social Work Association. It is unclear to me how it is going to be enforced. The most recent iteration came out earlier this month. 

The rule was amended in the recent 2022 Physician Fee Schedule as follows: 

“Section 123 of the CAA removed the geographic restrictions and added the home of the beneficiary as a permissible originating site for telehealth services furnished for the purposes of diagnosis, evaluation, or treatment of a mental health disorder. Section 123 requires for these services that there must be an in-person, non-telehealth service with the physician or practitioner within six months prior to the initial telehealth service and requires the Secretary to establish a frequency for subsequent in-person visits. We are implementing these statutory amendments, and finalizing that an in-person, non-telehealth visit must be furnished at least every 12 months for these services, that exceptions to the in-person visit requirement may be made based on beneficiary circumstances (with the reason documented in the patient’s medical record), and that more frequent visits are also allowed under our policy, as driven by clinical needs on a case-by-case basis.” 

The whole rule can be found at https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2022-medicare-physician-fee-schedule-final-rule

The "beneficiary circumstances" seem to offer a way to avoid seeing patients in person but this will need to be clarified by HHS. In any case, the time period has been extended from 6 months to 12 months for in-person meetings. 

As for how to fight this rule, CSWA is working on a two-pronged approach. We encourage all mental health associations to oppose it through letters to HHS and CMS. All individual clinicians can oppose it by writing to our senators and representative about the chilling effect this rule will have on telemental health treatment, especially in this pandemic when emotional distress is high and meeting in person may be dangerous. 

This will be a long-term fight in my view and there is no alternative to holding the government's feet to the fire.  

Laura W. Groshong, LICSW, Director, Policy and Practice

Clinical Social Work Association 
lwgroshong@clinicalsocialworkassociation.org 
CSWA - "The National Voice for Clinical Social Work"

Strengthening IDENTITY, Preserving INTEGRITY, Advocating PARITY

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