Medicare and Telehealth After the PHE: FAQs

Will CMS reimburse for outpatient therapy services delivered via telehealth in a private practice setting after May 11, 2023? Will CMS reimburse for outpatient therapy services delivered via telehealth in a hospital outpatient therapy department who submits claims on a 1500-claim formafter May 11, 2023? When would a hospital outpatient therapy department submit claims on a 1500-claim form instead of a UB-04 claim form? Will CMS reimburse for outpatient therapy services delivered via telehealth in a non-private practice setting after May 11, 2023? If a private practice is providing outpatient therapy services via telehealth, what is the place of service code I should use on the 1500-claim form? When billing for outpatient therapy services delivered via telehealth, what moodifier(s) should be placed on the CPT code(s) on the claim form? Now that the PHE has ended, must we use a HIPAA compliant format when delivering telehealth services? Where can I access the current list of telehealth CPT codes that can be utilized by PT, OT and SLP? When does the list of telehealth services provided by PT, OT and SLP expire? Are there any CPT codes on the telehealth list that can be provided by audio-only communication? Must I be licensed in the state where the patient is physically located during the telehealth visit? If a patient usually resides in the state where I practice and I am licensed in, but for a temporary basis, has gone to live with family in another state where I am not licensed, can I do a telehealth visit with that patient and submit the claim to their insurance carrier? If a patient usually resides in the state where I practice and I am licensed in, but for a temporary basis, has gone to live with family in another state where I am not licensed, can I do a telehealth visit with that patient if they are paying me cash and I am not submitting a claim to their insurance carrier? Can the practitioner (PT, OT, SLP) be out of the country, provide a telehealth visit to a Medicare beneficiary in a state that the practitioner is licensed in and bill this telehealth visit to their Medicare Administrative Contractor? If the therapist is in one state and is enrolled with the Medicare Administrative Contractor (MAC) for that state and the Medicare beneficiary who is having the telehealth visit resides in a different state with a different MAC, to which MAC does the therapist submit the claim to? Where can I access the most current information from CMS?

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