ASHA Continues Seeking Medicare Telepractice Authority; Interim Final Rule Insufficient

March 31, 2020

The Centers for Medicare & Medicaid Services (CMS) issued an interim final rule [PDF] providing additional flexibility for existing Medicare coverage of telepractice services, effective immediately. This rule did not expand Medicare telepractice coverage for audiologists and SLPs.

CMS likely crafted the interim final rule before Congress extended broader statutory authority last week to waive Medicare telepractice restrictions through enactment of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This means that CMS only had the authority to include additional services for telepractice but not additional types of providers. A fact sheet developed by CMS alludes to the additional services covered, but the interim final rule is clear that these telepractice services are not covered when provided by therapists, including SLPs. CMS specifically states in the interim final rule:

“However, we note that the statutory definition of distant site practitioners under section 1834(m) of the Act does not include physical therapists, occupational therapists, or speech-language pathologists, meaning that it does not provide for payment for these services as Medicare telehealth services when furnished by physical therapists, occupational therapists, or speech-language pathologists.”

ASHA remains committed to ensuring that CMS uses the authority Congress provided in the CARES Act to extend full telepractice coverage to audiology and speech-language pathology services as quickly as possible in order to preserve access to medically necessary care during the emergency period.

Although this rule added certain procedure codes typically billed by SLPs to the telepractice services list, only physicians and practitioners may currently bill these services via telepractice. The rule does not authorize SLPs to provide these or other services via telepractice. CMS did not reference audiology services as part of this interim final rule. However, ASHA has already called on CMS [PDF] to exercise the full extent of its waiver authority, as granted by the CARES Act, as quickly as possible and will continue to do so.

The Current Procedural Terminology (CPT ® American Medical Association) codes associated with speech-language pathology services that can be billed by physicians and practitioners, but not SLPs, under the interim final rule include:

92507: Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92521: Evaluation of speech fluency (e.g., stuttering, cluttering)
92522: Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523: with evaluation of language comprehension and expression (e.g., receptive and
expressive language)
92524: Behavioral and qualitative analysis of voice and resonance

CMS authorized coverage of select communication technology-based services in prior guidance for “e-visits” and is now allowing SLPs to perform virtual check-ins with their Medicare Part B patients, as represented by G2010 and G2012.

G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment
G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

As with “e-visits,” the “virtual check-ins” do not represent full telepractice coverage and do not replace evaluation, treatment, and diagnostic services. CMS’s guidance also clarified classification of the three “e-visit” codes as “sometimes therapy” codes requiring the use of the “GN” modifier when provided by SLPs. ASHA provides additional guidance on “e-visits” on the website.

CMS also authorized the use of specific telephone assessment codes by SLPs. (CPT codes 98966-98968.) These codes also require the use of the GN modifier because CMS classified them as “sometimes therapy” codes.

98966: Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
98967: Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
98968: Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion

ASHA will issue additional coding guidance on the use of these communication-based technology services shortly. ASHA will submit official comments by the May 2020 deadline.