Gap in Telehealth Flexibilities Could Harm Access to Care
By Hannah Wisterman

Although Congress recently extended many telehealth flexibilities through 2024, the decision is so far not reflected in Medicare’s 2023 physician fee schedule, leaving a potential gap of confusion and access to care for Texas physicians and patients.  

To close that gap, the American College of Emergency Physicians (ACEP), Texas Medical Association, and 44 other medical organizations are asking the Centers for Medicare & Medicaid Services (CMS) to issue an interim final regulation to align the Medicare fee schedule with the Consolidated Appropriations Act (CAA) of 2023. In particular, the move would allow for the continuation of payment for numerous telehealth codes, which some private insurers are also pursuing. 

Per the Medicare fee schedule, certain telehealth flexibilities are due to end 151 days after the existing public health emergency expires, scheduled for May 11. That would end some telehealth privileges in early October, leaving a period of months without continuation of some of the waivers authorized by the CAA.  

TMA continues to advocate that certain telehealth flexibilities be made permanent and virtual services be paid at parity with in-person visits. Meantime, TMA has created a chart detailing which telehealth flexibilities would end when, and what that means for practices. ACEP also compiled a chart of which codes are affected

If the gap were to persist, “certain codes would be, at least temporarily, removed from the Medicare Telehealth Services List – thereby creating an unintended barrier to accessing vital health care services. Many Medicare beneficiaries who have been dependent on receiving care virtually would have trouble finding suitable alternatives to meet their needs,” medicine wrote in January to CMS Administrator Chiquita Brooks-LaSure. 

Extending the Medicare codes would include extending coverage for audio-only modalities, something private insurers have already begun to do. 

The American Medical Association last year established modifier 93, and the associated Appendix T in Current Procedural Terminology, to define and create codes for real-time interactive audio technology, such as a phone call.  

UnitedHealthcare already has opted to align with AMA’s codes and pay physicians for those audio-only telehealth options listed in Appendix T. TMA experts say the decision underscores a larger pattern of insurers and physicians shifting their resources into telehealth. 

Last Updated On

February 22, 2023

Originally Published On

February 22, 2023

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Hannah Wisterman


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Hannah Wisterman is an associate editor for Texas Medicine and Texas Medicine Today. She was born and raised in Houston and holds a journalism degree from Texas State University in San Marcos. She's spent most of her career in health journalism, especially in the areas of reproductive and public health. When she's not reporting, editing, or learning, you can find her exploring Austin or spending time with her partner, cat, and houseplants.

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