As has been reported in previous editions of CCHP’s weekly #TelehealthTuesday emails, including last week’s March newsletter, the Medicare telehealth waivers were extended through December 31, 2027 as a result of the passage of HR 7148 – The Consolidated Appropriations Act, 2026. However, the extension was not the only important telehealth-related item in HR 7148. The bill also contained several policies that may be new and unfamiliar since they have not previously appeared within existing federal telehealth policy. Below we will highlight four independent items within HR 7148 that readers may want to review.
BILLING MODIFIERS FOR THIRD PARTY VIRUTAL PLATFORMS
The Centers for Medicare and Medicaid Services (CMS) will be required to have billing modifiers by 2027 to identify telehealth services delivered through third party virtual platforms with whom a clinician contracts or has a payment arrangement, and when telehealth is billed “incident to” another professional service.
Currently, CMS requires that submission of telehealth claims contain the following modifiers:
| Modifier |
Description |
| 95 |
Synchronous/Real-time audio and visual |
| 93 |
Audio-only |
| GQ |
Asynchronous (limited to Alaska and Hawaii and demonstration programs) |
| FQ |
FQHC/RHC audio-only |
These current modifiers are used to inform CMS of which type of telehealth modality was used to deliver the service, whereas the new modifiers that are to be developed will be used to identify whether a contracted third-party virtual platform is used to deliver the service, as well as to identify when the service is being billed “incident to” another professional service. CMS has allowed third-party platforms to be used to deliver telehealth services, though it has cautioned providers to notify patients about potential privacy risks and to be sure steps to enable encryption and protect privacy are taken.
One potential reason for the creation of these additional modifiers could include the wish to have more data regarding how services are being delivered to Medicare enrollees via telehealth. The current modifiers only provide information on the modality being used, but the new modifiers will tell CMS more about the type of provider utilizing telehealth, such as how many practitioners have an arrangement with a third-party that has the infrastructure to deliver those services, or if the services are being billed by an individual provider. This additional information about payment structures would support the federal government’s goal of greater transparency around federal spending, as well as provide additional information about the different telehealth models being utilized in Medicare to provide remote care (see past CCHP newsletters regarding Hybrid Models, Direct-To-Consumer Telehealth, and Senators Question Pharmaceutical Companies’ Use of Telehealth Platforms for more information).
As the new modifiers are required to be in place by 2027, it is likely CMS will include them in their 2027 Physician Fee Schedule (PFS) proposals, which typically come out each summer. The PFS is the major regulatory vehicle CMS utilizes to make changes or updates to their Medicare policies for the following year. Once proposals are published in the PFS (usually occurs in July), the public will have an opportunity to provide comments prior to the final PFS being released, which typically occurs each year in November.
MEDICARE FOR CARDIOPULMONARY REHABILITATION SERVICES
Through CY 2027, allows for hospitals to furnish and bill Medicare for cardiopulmonary rehabilitation services delivered to hospital outpatients in their homes via live video.
Cardiopulmonary rehabilitation is a program that’s designed to help a patient’s recovery after a cardiac event. It is medically supervised and usually involves exercising, emotional support, and education. It not only helps with the patient’s recovery but also puts them on the path to a healthy lifestyle and improved quality of life. The patient is closely monitored throughout the program.
This policy addresses a gap in permanent policy related to cardiopulmonary rehabilitation. Under permanent policy, physician office-based programs are eligible for reimbursement if telehealth is used, but hospital outpatient provider departments were not. The allowance for the hospital outpatient departments to provide these services via live video in the home is temporary only through the end of 2027. It should be noted this waiver is only for allowing the services to be provided via live video and does not include audio-only. As noted in the earlier section about modifiers, it is possible any policy instructions CMS might have around billing for these services could appear in the 2027 PFS proposals.
EDUCATION FOR CLINICIANS
Requires CMS to educate Medicare clinicians by January 1, 2028 on screening for medication-induced movement disorders in at-risk patients, including best practices for telehealth screening and how such services should be reflected in billing.
Medication-induced movement disorders are exactly what they sound like: certain medications may cause involuntary motor symptoms such as tremors, rigidity or spams. Medications that can cause these movement disorders include antipsychotics, antiemetics and some antidepressants. Screening tools are used to assess specifics about a patient’s disorder. Depending on what may be causing the disorder, different screening tools may be used. For example, movement disorders caused by Parkinson’s disease might require a different screening tool than movement disorders caused by medication.
This particular policy focuses on movement disorders caused by medication and charges CMS with educating Medicare providers regarding screening such a disorder, including best practices for doing so via telehealth. For instance, a study published in 2023 in the Telemedicine e-Health Journal noted that utilizing telehealth to assess a patient for tardive dyskinesia (a movement disorder related to prolonged exposure to dopamine receptor blocking agents) could be a useful tool if combined with periodic in-person visits.
In the policy passed by HR 7148, CMS is charged with providing Medicare clinicians with best practices information on using telehealth for screening for medication-induced movement disorders, as well as how that service would be reflected in billing. CMS must provide this information by January 1, 2028. It was not specified how this information should be relayed to providers so it may take the form of a Medicare Learning Network (MLN) fact sheet, or it could come via an alert, or as noted earlier, CMS may provide something in the upcoming PFS. However, since the deadline to provide this information isn’t until January 1, 2028, it remains a possibility that if the PFS is indeed utilized to meet this requirement, it may not appear in the CY 2027 set of proposals, rather it may instead fall within the CY 2028 PFS.
GUIDANCE ON BEST PRACTICES
Health and Human Services (HHS) must issue guidance within one year of this bill’s enactment on best practices for delivering telehealth services to patients with limited English proficiency.
According to a JAMA article published in 2024, patients with limited English proficiency tend to have poorer experiences with telehealth encounters, or are even less likely to utilize telehealth at all. The study noted that 32% of limited English proficient patients reported a poor experience during a telehealth encounter, compared to 26% for those patients proficient in English. Limited English proficient patients also accounted for only 6.8% of video visits and 8.1% of telephone visits. This type of data may have prompted the addition of this item in HR 7148.
The directive is to have best practices guidance available in 2027. It is unknown at this time what approach HHS may take in developing and dispersing such guidance, but hopefully it will include the engagement of practitioners and other stakeholders to help in the development of such materials. HHS does currently have guidance on nondiscrimination in telehealth, which includes suggestions regarding addressing language barriers, such as considerations to take when selecting a platform to deliver services.
Other existing resources include the Virginia Telehealth Network’s webpage for patients with limited English proficiency, which contains resources on training interpreters for behavioral health and optimizing care for limited English proficiency patients. Additionally, some organizations, such as the HITEQ Center, also have telehealth strategies for serving patients with limited English proficiency. HHS may wish to explore existing resources such as these to help build the best practices guidance.
IN SUMMARY
It is always important to monitor what CMS does with the PFS each year as there is always the potential that new telehealth policies for Medicare will be created or altered. However, with these additional directives from Congress, the CY 2027 PFS may have increased importance as it may be used as a vehicle to implement some of these new policies. CCHP will continue to monitor how the designated federal agencies charged with administering the above policies will approach these efforts.
Stay tuned to future CCHP newsletter editions for further developments! If you haven’t done so already, and would like to sign up to receive future #TelehealthTuesday emails from CCHP, you can do so at the bottom of our contact us page. |
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