Telehealth After COVID-19
Frequently Asked Questions
Is telehealth going away after the Public Health Emergency (PHE) ends?
No, but many changes occurred in 2023, and more changes are coming. Most telehealth encounters still require BOTH audio and video. Legislators continue to strongly support permanent telehealth coverage for mental health disorders, for substance abuse disorders, and for rural areas. Payment parity (same reimbursement as in-person care) is unlikely once temporary policy flexibilities and extensions expire.
Can I provide telehealth to patients out of state?
No (generally). Providers must be licensed in the state the patient is physically in at the time of the telehealth service. Telehealth policies widely vary state-by-state.
Can new patients continue to be seen via telehealth?
It depends on the telehealth modality. Virtual check-ins and Remote Patient Monitoring (RPM) can only be used for established patients. New patients can be seen via virtual office visits temporarily, but there are now stricter in-person requirements for controlled substances.
Can I prescribe new controlled substances via telehealth?
Only if an in-person evaluation has been done by the provider beforehand, for schedule II-V drugs. However, qualifying practitioners can prescribe buprenorphine to new and existing patients with opioid use disorder based on a telephone evaluation.
Can I refill a controlled substance via telehealth for an established patient?
•Under certain conditions. The DEA has temporarily expanded PHE flexibilities for schedule II-V controlled substances until Nov. 11th, 2024 (for patients established with providers prior to Nov. 11, 2023). After that date, Schedule II drugs like Vicodin, OxyContin, Adderall, and Ritalin will require an in-person visit before they can be prescribed virtually, and Schedule III-V drugs like codeine, Xanax, Ambien, and buprenorphine can only be prescribed for an initial 30-day period. After the initial 30-days, a patient will need to see the doctor in-person once to get a refill. •Florida law SB 312 permanently allows for prescribing schedule III-V drugs via telehealth in Florida, but prohibits prescribing Schedule II controlled substances unless an exception is met: 1. The treatment of a psychiatric disorder 2. Inpatient treatment at a hospital licensed under chapter 20 395 3. The treatment of a patient receiving hospice services as defined in s. 400.601 4. The treatment of a resident of a nursing home facility as defined in s. 400.021
Will I continue to be paid the same for a telehealth visit as an in-office visit?
•No. Traditional Medicare B will continue to pay the same rate through Dec. 31st, 2023. All other payers will begin reducing reimbursement after May 11th, 2023 (end of PHE). •For Medicare patients until Dec 31st, 2023, providers should use the place of service (POS) that would have been used if the patient was seen in person rather than POS 02 telehealth. If the patient would have been seen in the office, using POS 11 results in a higher non-facility payment (same as in office). If POS 02 is used, it results in a lower payment, at the facility rate.
Can my patient continue to be at home for a telehealth visit, regardless of whether they live in a rural or urban location?
For Medicare patients only for now, until Dec. 31, 2024, as stated in the Consolidated Appropriates Act (CAA) of 2023. Commercial insurance companies are not required to follow this policy, and so they may not permit a patient’s home to be an “originating site”.
Can I continue to do Medicare Annual Wellness Visits via telehealth?
For now, until Dec. 31st, 2024. In the CY 2023 Final Rule, CMS defined temporarily available telehealth services, with the extension timeframe enacted by the CAA of 2023, further extending flexibilities through CY 2024.
Will I still be reimbursed for audio-only patient encounters (phone calls) ?
•For most payers - No, and for Medicare, yes temporarily. CMS will pay for audio only telehealth until Dec. 31, 2024, at the same rate as office visits using codes 99441-99443. The AMA has developed a new modifier, -93 for audio only services. Medicare is requiring its use in 2023. •Congress passed a law in 2020 mandating that after the PHE ends, behavioral health services will continue to be allowed via telehealth, audio/visual AND audio only.
Can I still perform telehealth visits from my home?
Under certain conditions. After Dec. 31st, 2023, if a provider wishes to perform telehealth visits from home, he or she is required to report a home address on the Medicare enrollment site.
Can I continue to use Doximity to provide telehealth services?
Yes. Telehealth platforms must be HIPAA compliant, which includes companies like Doximity, Zoom for Healthcare, Doxy.me, ThinkAndor, GoToMeeting, and others. Apple FaceTime is not currently HIPPA compliant.
Can residents and fellows still participate in telehealth services?
Under certain conditions. Virtual supervision is no longer allowed in metropolitan areas, although CMS is allowing virtual supervision of residents until Dec. 31, 2023. The attending must be in the same physical location as the resident/ fellow. Level 4 and higher visits require an attending physician to “see” the patient for sites under the primary care exception (resident has been with primary care training program for at least 6 months).