Teledermatology and the COVID-19 pandemic
Federal telehealth flexibilities extended through 2024
The COVID-19 Public Health Emergency (PHE) ended on May 11, 2023. However, the Consolidated Appropriations Act (CAA) of 2023 extended many of the telehealth flexibilities and waivers through Dec. 31, 2024. Additionally, the 2024 Medicare Physician Fee Schedule (MPFS) introduced policy adjustments and extensions concerning telehealth services.
The telehealth flexibilities which will continue through 2024 include:
Allowing Medicare telehealth services to be furnished to patients located anywhere within the U.S., including an individual’s home. Dermatologists must still follow the state licensure laws of the state where the patient is located at the time of visit. Access this FSMB resource on modified state requirements (PDF) for more information.
Continued payment for telehealth services furnished by RHCs and FQHCs using the methodology established for those telehealth services during the COVID-19 PHE.
Continued coverage and payment of telehealth services (including audio-only telehealth services) included on the Medicare Telehealth Services List through 2024.
Allowing teaching physicians to use audio/visual real-time communication technology to be present when the resident furnishes Medicare telehealth services in all residency training locations through the end of 2024; teaching physicians and residents do not have to be co-located.
Allowing direct supervision by a supervising practitioner through real-time audio and video interaction telecommunications through 2024.
Allowing clinicians who render telehealth services from their homes to list their practice address instead of their home address on their Medicare enrollment through 2024.
Note, these telehealth flexibilities do not apply to private payers. We encourage practices to check with private payers before providing the service to ensure appropriate reimbursement expectations.
Visit HHS’s Policy Changes after PHE page for more information.
Teledermatology after the COVID-19 PHE
Select from the topics below to learn more about how regulations and policies have changed with the end of the PHE.
HIPAA compliance and telehealth vendors
During the PHE
HHS stated it will use discretion in collecting penalties for the “good faith use of telehealth.” To be clear, under this Notice, physicians were able to use popular applications that allowed for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA rules. Physicians should not have used Facebook Live, Twitch, TikTok, or other public-facing communication services. Physicians were encouraged, but not required, to notify patients of the potential security risks of using these services and to seek additional privacy protections by entering into HIPAA business associate agreements (BAA). Please review the Academy‘s resources on choosing the right vendor for your practice.
After the PHE
HHS has issued notice that it will end the enforcement discretion described above after a 90-day transition period following the PHE. Clinicians have until Aug. 9, 2023 to comply with the HIPAA rules that applied before the PHE.
Physicians must ensure their platform is HIPAA compliant and will sign a business associate agreement. HHS provides a list of vendors who state they follow HIPAA and will sign a BAA. However, the Academy urges dermatologists to confirm with their platform that it follows all HIPAA requirements before providing telehealth services.
Originating site and geographic restrictions
During the PHE
Dermatologists could bill telehealth visits for any patient in any location due to lifted restrictions.
After the PHE
This flexibility has been extended through Dec. 31, 2024. Medicare patients can continue to use telehealth services at any location in the U.S.
Medicare virtual check-in
During the PHE
Dermatologists and non-physician clinicians could provide virtual check-in services to both new and established patients.
After the PHE
These services may only be provided to established patients.
Telephone calls
During the PHE
Medicare allowed telephone-only encounters (CPT codes 99441 - 99443) to be reimbursed at the same rate as established patient E/M codes 99212 – 99214 until the end of 2023.
Updates on whether these services remain on the Medicare Telehealth Services List for 2024 and beyond will be addressed through established processes as part of the 2024 Medicare Physician Fee Schedule (MPFS) proposed and final rules. For national MPFS rates, visit the Reimbursement tab.
After the PHE
The CAA allows for all audio-only telehealth services for Medicare patients to be covered through Dec. 31, 2024.
Place of service code and modifier usage
During the PHE
Virtual E/M visits were considered the same as in-person visits and were paid at the same rate as regular, in-person visits. You were required to utilize modifier 95 and a place of service (POS) code of 11 to receive reimbursement at the non-facility rate for Medicare. Virtual visits could also be based on medical decision making or time rather than documentation of history and/or physical exam in the medical record.
After the PHE
CMS indicates there will be no changes to POS until after Dec. 31, 2024. The Academy will inform members when CMS does make changes to POS requirements.
Reporting home address
During the PHE
Physicians and non-physician clinicians could provide telehealth services from their home while continuing to bill from their currently identified practice location without having to update this in their Medicare enrollment.
After the PHE
Per the 2024 MPFS Final rule, CMS will continue to allow clinicians who render telehealth services from their homes to list their practice address instead of their home address on their Medicare enrollment through 2024.
Please reach out to your Medicare administrative contractor for help if you need to update your enrollment information.
Medicare physician supervision requirements
During the PHE
CMS temporarily modified the regulatory definition of direct supervision, which required the supervising dermatologist or non-physician clinician to be “immediately available” to furnish assistance and direction during the service, to include “virtual presence” of the supervising dermatologist through the use of real-time audio and video technology.
After the PHE
Per the 2024 MPFS Final rule, CMS will continue to allow direct supervision by a supervising practitioner through real-time audio and video interaction telecommunications through 2024.
For additional guidance, please see CMS Fact Sheet on Transition from the COVID-19 (PDF) and Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19 (PDF).
For questions, contact us.
