Audio-Only Services in the Year 2024
Medicare Coverage and Reimbursement
On November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) issued the final rule on the Medicare physician fee schedule detailing how healthcare services offered by psychologists and other providers will be delivered and reimbursed in 2024. Below are some of the key issues of interest to psychologists and other healthcare providers related to audio-only services in year 2024:
Audio-only Services for Mental Health
- Reimbursement: Reimbursement for audio-only services for mental health will continue in 2024.
- Originating site requirement: The originating site requirement will not apply when patients receive audio-only services in their homes. The definition of the home is viewed broadly to include temporary lodging, such as a hotel.
- Exclusions: Health Behavior Assessment and Intervention services will be excluded from audio-only coverage in 2024.
- In-person visits: In-person visits are not required for audio-only services. However, providers may require an in-person visit if they believe it would be beneficial for the patient.
Audio-only Services for Substance Use Disorders (SUD)
- Reimbursement: Reimbursement for audio-only services for SUD will continue in 2024.
- Originating site requirement: The originating site requirement will not apply when patients receive audio-only services in their homes. The definition of the home is viewed broadly to include temporary lodging, such as a hotel.
- Exclusions: Health Behavior Assessment and Intervention services will be excluded from audio-only coverage in 2024.
- In-person visits: In-person visits are not required for audio-only services. However, providers may require an in-person visit if they believe it would be beneficial for the patient.
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
- Patients in FQHCs and RHCs: Patients in FQHCs and RHCs can receive mental health and SUD services through audio-communications technology.
- In-person visits: The patient must have received an in-person service within six months of the initial telehealth service.
- Modifier: The telehealth visit must be billed with a modifier. A modifier consists of two characters and is listed on the claim form to provide additional information about the service.
- Behavioral health services: Behavioral health services in RHCs and FQHCs will not be eligible for reimbursement as a telehealth service unless provided with two-way audio-visual communications technology.
Medical Billing and Coding for Audio-Only Services
- HCPCS codes: Providers should use the following HCPCS codes for audio-only telehealth services:
- 90862: Audio-only telephone service (includes psychotherapy, evaluation, and management)
- 90863: Audio-only telephone service (for psychotherapy only)
- Modifiers: Providers should use the following modifiers when billing for audio-only telehealth services:
- GV: Audio-only telephone service provided without two-way audio-visual technology
- GX: Patient did not consent to two-way audio-visual technology
- Documentation: Providers should document the following in the patient’s medical record:
- The reason why an audio-only service was provided
- The patient’s consent to the use of audio-only technology
- The patient’s response to the audio-only service
To summarize,
Audio only telehealth services for mental health and substance use disorders (SUD) will continue to be covered by Medicare in 2024. Providers can offer these services to patients in their homes without the need for two-way audio-visual technology. In-person visits are not required but may be requested by providers if deemed beneficial. Providers should use specific billing modifiers and document the rationale for providing audio-only services. In addition to the above information, providers should also be familiar with the CMS resources like the Medicare Telehealth Fact Sheet and Medicare Physician Fee Schedule Final Rule
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The American Medical Association (AMA) owns the copyright for the Current Procedural Terminology (CPT) coding system. The AMA developed and maintains the CPT code set, regularly updating it to reflect changes in medical practices, technology, and healthcare regulations.
