Telemedicine Billing, Coverage to Change with PHE End: Here’s How
By Alisa Pierce

*Editor's note: The Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration issued on May 9 a temporary rule extending PHE-related telehealth flexibilities for prescribing controlled medicines through Nov. 11, 2023. For patient-physician telemedicine relationships established by Nov. 11, 2023, these flexibilities will be extended for an additional year, through Nov. 11, 2024. 

The end of the COVID-19 public health emergency on May 11 will kick off a series of changes to telehealth coverage and billing as physicians have known them for the past several years. Texas Medical Association experts were at the ready to prepare and educate physicians on the transition during a recent Ask the Expert event.  

Pandemic-era state and federal regulations had relaxed regulatory and payment barriers to telehealth care, including allowing the use of non-HIPAA-compliant platforms and waiving geographic site restrictions that would normally require a patient to be seen in person or at an approved distant site such as a federally qualified health center.  

But those flexibilities – including paying for most telemedicine visits at the same rate as in-person visits – will wind down with the PHE, says Shannon Vogel, TMA’s associate vice president of health information technology.  

For Texas-regulated insurance plans, “Texas has coverage parity, which means that the service is covered regardless of if it’s in-person or [via] telemedicine, but we don't have payment parity,” she said during the event.   

Physicians should watch for updates from private payers who may still offer parity after the PHE, like Cigna, she added. TMA also is working to provide up-to-date information on the issue. 

On Jan. 1, 2024, Medicare will no longer pay physicians for telemedicine appointments at the same rate as in-person visits, and instead pay physicians at the lower facility rates.  

Under distant site requirements, a patient may travel to a rural health clinic and have a nurse practitioner or primary care physician facilitate a telemedicine visit with a specialist located in an urban area – but both the specialist and the distant-site practitioner would receive payment, and physicians should still bill for their services provided at the distant site. 

Documenting and billing for telehealth services provided outside and inside a patient’s home, respectively, also will change. 

However, audio-only visits for behavioral health will still be allowed under Medicare. 

As for telehealth platforms, the federal government recently gave clinicians an additional 90 days after the PHE ends, until Aug. 9, to ensure their systems are HIPAA-compliant. To help physicians and their practice staff navigate these changes, physicians can visit the following TMA resources:   

Ms. Vogel shares a good rule of thumb when looking for HIPPA-compliant technology is to enter into a business associate agreement with the vendor and points to TMA’s sample agreement on its HIPAA Resource Center

“If a platform is not HIPAA-compliant, they won't sign an agreement,” she said. 

Changes to virtual supervision, prescribing

Other pandemic flexibilities for telemedicine services, including virtual physician supervision of nonphysician practitioners (NPPs) and the prescription of controlled substances to patients seen via virtual visits, will end with the PHE as well. 

During the pandemic, the Centers for Medicare & Medicaid Services temporarily allowed physicians to supervise NPPs with real-time audio and video technology.  

But starting Jan. 1, 2024, to qualify for full payment, Medicare will require the supervising physician to be in the same physical location as any NPP to whom he or she has delegated authority, unless the practice is in a rural area. 

However, Medicare will require general supervision, rather than direct supervision, when it comes to virtual behavioral health care starting next year.  

“The physician’s presence may not be required, but the services must still be under the physician’s overall direction and responsibility,” Ms. Vogel explained. 

Additionally, physicians will no longer be allowed to prescribe narcotics via telehealth unless one in-person visit with a patient has been conducted. After the initial in-person visit, the physician and patient can meet virtually going forward. 

Ms. Vogel cautioned physicians should be mindful of Texas Medical Board rules regarding pain management through virtual care, which state that treating chronic pain with scheduled drugs via telemedicine by any means other than audio and two-way video communication is prohibited, unless a patient: 

Is an established chronic pain patient of the physician or health professional issuing the prescription; 

Is receiving a prescription identical to one issued at the previous visit; and 

Has been seen by the prescribing physician or health professional in the last 90 days, either in-person or by telemedicine using audio and two-way video communication. 

TMA is working on making recordings of this event available soon. Check out TMA’s previous and upcoming “Ask the Expert” sessions. For help navigating a post-PHE telehealth landscape, visit TMA’s expansive telemedicine resources

Last Updated On

May 09, 2023

Originally Published On

May 05, 2023

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Alisa Pierce

Reporter, Division of Communications and Marketing

(512) 370-1469
Alisa Pierce

Alisa Pierce is a reporter for Texas Medicine. After graduating from Texas State University, she worked in local news, covering state politics, public health, and education. Alongside her news writing, Alisa covered up-and-coming artists in Central Texas and abroad as a music journalist. As a Texas native, she enjoys capturing the landscape on her film camera while hiking her way across the Lonestar State.

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