Therapists To CMS: Use Authority To Avert Telehealth Cliff May 11

By Emma Beavins / May 03, 2023 at 3:55 PM

Several therapy associations sent a letter today (May 3) asking CMS to clarify that telehealth therapy services can continue after May 11, when the public health emergency ends, through December 2024. The therapists were taken aback when CMS officials recently told them certain telehealth visits could no longer be billed after May 11, as first reported by Inside TeleHealth, and they demand CMS use its authority to avert a telehealth cliff.

The therapy groups specifically ask CMS to clarify that facility therapists in hospital outpatient departments, skilled nursing facilities and rehabilitation agencies who bill Part B can continue to bill for telehealth beyond the emergency pandemic waivers.

They assert CMS could use its statutory authority in sections 4113 and 4140 of the Consolidated Appropriations Act of 2023 -- which supports the provision of outpatient therapy services via telehealth through 2024 -- to allow outpatient telehealth therapy to be billed, regardless of setting.

The organizations also cite the Medicare Benefit Policy Manual and the Physician Fee Schedule as the basis of their legal argument to CMS.

The therapy stakeholder groups querying CMS are the American Physical Therapy Association, American Occupational Therapy Association and American Speech and Hearing Association, all of whom could face a telehealth cliff in eight days if CMS follows through on officials’ recent assertions that certain outpatient therapists can no longer bill for telehealth post-PHE.

The letter states that in at least two national provider calls, CMS said telehealth services can no longer be reported on the UB04 form after May 11. The providers used that form to bill telehealth therapy in conjunction with the Hospitals Without Walls pandemic waiver that is coming to an end.

Facility outpatient therapists used the UB04 claims form to bill their telehealth services during the pandemic, even though hospital outpatient therapy providers have traditionally been governed by CMS’ Physician Fee Schedule, Kate Gillard of APTA told Inside TeleHealth last week. CMS officials on the recent calls told therapists that hospital outpatient department therapy is now governed by the Hospital Outpatient Prospective Payment System because of the therapists’ use of UB04.

However, therapists who bill with the 1500 form under the Physician Fee Schedule will still be able to bill for telehealth, CMS said, because they are individual providers.

“This has led many to infer that the ability to perform telehealth post-PHE rests on the claim form a facility uses,” the letter says.

The associations cite Chapter 6 of the Medicare Benefit Policy Manual, which says that physical and occupational therapy and speech-language pathology services are exempt from the OPPS and instead are paid under the physician fee schedule.

They add that the Consolidated Appropriations Act section 4140 seems to grant them the authority to continue to provide and bill CMS for telehealth services, and they quote the listed sites from section 4114 that Congress said count as allowable telehealth sites, including skilled nursing facilities, hospitals and the offices of a health care practitioner, among others.

The associations assert the CAA authorizes them to be telehealth providers through 2024.

“For these institutional providers and the Medicare beneficiaries they serve, removal of telehealth flexibilities in the next 2 weeks may be inappropriate and, without effective communication, will create significant access to care and quality of care concerns. Further, heightened administrative burden will ensue, including the need to make operational adjustments and immediately provide education to clinicians on the changes in advance of the end of the PHE. Ultimately, this policy creates significant risk for reduced beneficiary access to medically necessary therapy services, especially in rural and underserved areas where telehealth has been most effectively utilized during the pandemic with very little notice,” the letter says. -- Emma Beavins (

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