Advocacy Needed for Telehealth with Medicare

Occu­pa­tion­al Ther­a­py, Phys­i­cal Ther­a­py and Speech Ther­a­py are only allowed to use tele­health dur­ing the Pub­lic Health Emer­gency for indi­vid­u­als with Medicare as their insur­ance provider. Once the Pub­lic Health Emer­gency is over, ther­a­pists will imme­di­ate­ly not be reim­bursed for tele­health ser­vices provided.

There is con­fu­sion around CMS adding many of the com­mon­ly used ther­a­py CPT codes on a Cat­e­go­ry 3 basis. CMS has said that these cat­e­go­ry 3 CPT codes may be billed through the end of the year in which the Pub­lic Health Emer­gency ends. Because many ther­a­py CPT codes are on this list, many have assumed that ther­a­py staff can auto­mat­i­cal­ly use tele­health at least through the end of 2021.

Once the Pub­lic Health Emer­gency ends, ther­a­py staff must imme­di­ate­ly stop using tele­health if they wish to be reim­bursed by Medicare.

These Cat­e­go­ry 3 com­mon ther­a­py CPT codes may be used for tele­health through the end of the year when billed by some­one who is not a ther­a­pist. For exam­ple, after the Pub­lic Health Emer­gency ends, a nurse prac­ti­tion­er could bill tele­health for ther­a­peu­tic exer­cise 97110 but an OT or PT could not bill Medicare for this via telehealth.

After the Pub­lic Health Emer­gency, the only way a ther­a­pist could con­tin­ue to bill for tele­health for Medicare is if con­gress would make OT, PT, ST providers approved tele­health providers.

Our leg­isla­tive advo­ca­cy must remain to make OT, PT, and ST ser­vices per­ma­nent­ly approved tele­health providers for Medicare.