Alliance Wins in the Proposed Medicare Fee Schedule

Alliance Wins in the Proposed Medicare Fee Schedule

July 11, 2024

While CMS does not currently have statutory authority to waive geographic and originating site restrictions for telehealth, it has proposed a number of important steps to preserve access to telehealth in the CY2025 Physician Fee Schedule.

• Extension of provider location reporting flexibility: Proposed continuation of current policy through 2026 allowing a distant site practitioner to use their currently enrolled practice location instead of their home address when providing telehealth services from their home.  The Alliance has aggressively advocated for permanent change, most recently in a June letter to CMS.
• Permanent authority for audio-only:  CMS proposes to permanently allow two-way, real-time audio-only communication technology for any telehealth service furnished to a beneficiary in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system but the patient is not capable of, or does not consent to, the use of video technology.
• Virtual Direct Supervision: CMS has proposed a new permanent authority for virtual direct supervision of incident to services.  It has also continued broader existing virtual direct supervision authority through 2025.  This includes the current policy allowing teaching physicians to have a virtual presence for purposes of billing for services furnished involving residents in teaching settings who are offering a virtual service.
• Rejection of separate coding for telehealth: CMS has proposed not to cover new telehealth codes that duplicate existing telehealth-eligible services covered by Medicare.  The Alliance applauds this decision, which follows our advocacy this spring to ensure Medicare telehealth services remain equivalent to in-person care.  We believe that telehealth is a modality for providing health care, it is not a different service.

In addition to these highlights, the Alliance will provide CMS with a detailed response to both positive and negative elements of the proposed rulemaking.

The Alliance calls on Congress to take the next step and ensure full statutory authority exists to maintain access to Medicare telehealth services in 2025.