Following advocacy from the Texas Medical Association and medical student members, the Centers for Medicare & Medicaid Services (CMS) created a place of service code for street medicine, making it possible for physicians to get paid for services provided to people who are currently unhoused effective Oct. 1.
The “outreach site/street” code 27 is intended for a non-permanent location on the street, or a so-called “found environment” (such as encampments or shelters), not described by any other code where “health professionals provide preventive, screening, diagnostic, or treatment services to unsheltered homeless individuals,” per the U.S. Department of Health & Human Services.
Before TMA advocacy, there was no place of service codes that physicians could use for care delivered outside a facility, and physicians offering street medicine had no clear guidance on how to bill for it, said Anand Singh, a third-year medical student at Anne Burnett Marion School of Medicine at Texas Christian University who advocated for the change.
“The lack of a place of service code caused several barriers to provide care to unhoused Texans,” he said. “Physicians who deliver care to patients outside a typical office or even a mobile clinic can now be reimbursed for their services, legitimizing the practice of street medicine, and delivering care to those who often need it most.”
Mr. Singh brought the issue to TMA’s House of Delegates (HOD) along with his colleagues from medical schools across the state during last year’s TexMed conference. They worked closely with TMA’s Committee on Medicaid, CHIP, and the Uninsured to elevate the HOD-adopted resolution to the American Medical Association this year, which called on CMS for the regulatory change.
The new code will allow Texas physicians to increase their understanding of the health care needs of people experiencing homelessness, says Fort Worth emergency physician J. Hunter Scarborough, MD. He is the first fellow in the street medicine fellowship program at the John Peter Smith Hospital located in Tarrant County and one of the TexMed presenters on the topic.
“Now that we have this specific code, it will be easier to pull data about how effective street medicine teams are, how cost-effective providing care is, and what kinds of patients we’re seeing,” he said. “Street medicine used to be very volunteer-based, but now we’re seeing more legitimate teams and more funding sources. This type of research could lead to the creation of a more robust understanding of street medicine and alert other medical professionals that we’re out here serving unhoused Texans.”
“I’m thankful TMA chose to elevate the issue and press CMS to make this change,” Mr. Singh said. “Without their charge, I’m not sure we would’ve been able to accomplish this.”
For hands-on help for billing and coding challenges, visit TMA’s Reimbursement, Review, and Resolution (RRR) service.