UPDATE: As of March 17, 2020, CMS has implemented temporary measures that allow greater use and reimbursement of telehealth for rehab therapists. Read more here.
Telehealth is not exactly new. In fact, medical professionals have been using telemedicine since as early as 1940—but that’s because the term “telemedicine” technically refers to any electronic transfer of patient information.
The way we think of telemedicine has changed quite a bit over the years. While the definition continues to encompass electronic transfer of medical records, most of us use the term “telehealth” to describe treatments or interventions delivered across electronic means.
PTs and Telethealth
Like other medical professionals, PTs have been incorporating some degree of telehealth into our practice for several years now (for example, our referring MDs transfer imaging to us, and we use EMRs and secure texting). Recently, though, telehealth physical therapy has gained some real traction, and with good reason.
What are the benefits of virtual visits and telehealth?
Not only can teletherapy help address the lack of access to PT services in the “PT deserts” across the US, but it also provides an option for short-term staffing coverage. For this same reason, many speech-language pathologists have also jumped on board. There has even been a surge of interest in telehealth occupational therapy, as each therapy discipline has its own respective share of underserved regions.
Telehealth is also a wonderful way to bring in niche or specialized services in the form of consults. For example, a patient in Arp, TX might not be able to see a dance specialist PT in person, but teletherapy technology could allow that patient to connect with said specialist via live video.
Why aren’t more PTs leveraging telehealth?
Clearly, there are many benefits to incorporating teletherapy into an existing practice; so why aren’t more PTs doing so? Well, many would-be telehealth adopters find themselves asking, “Can I bill for teletherapy services?” And unfortunately, the answer to that question isn’t so simple.
PTs’ ability to bill insurance companies for telehealth reimbursement depends on several factors, including (but not limited to) the type of insurance at play and state-specific laws.
Payer Variation for Telehealth Billing
If you’re interested in billing insurance providers for teletherapy, it’s important to understand that there are no across-the-board rules for this process.
Medicare does not include PTs, OTs, or SLPs on its current list of approved telehealth providers. So, if you’re wondering whether you can bill Medicare for telehealth services, the answer is currently “no.” Additionally, there are no telehealth-specific CPT codes at this time, but that could change in the future.
According to the APTA, Medicaid does reimburse for rehab therapy telehealth services in some states. Each state and payer has its own unique policy, which you can find by searching online or contacting individual provider representatives. This guide offers a comprehensive state-by-state explanation of telehealth coverage.
As mentioned above, each third-party payer has its own rules for telehealth reimbursement. We highly recommend contacting each payer you contract with to find out whether it reimburses for teletherapy––and if so, at which rates. And the rates can vary widely, which brings us to our next topic of discussion: parity laws.
In a recent interview, Rob Vining, PT, MSPT, the founder of PTLive, told WebPT that some states have telemedicine “parity laws,” which require private (third-party) payers to reimburse live telemedicine care at the same rates that they would reimburse in-person care.
To further complicate matters, parity laws vary by state, so simply knowing whether or not your state has one in place is not enough. You must still verify that a given payer covers a particular physical therapy service in the first place. Then, based on the language of your state’s law, you may be entitled to receive the same reimbursement for that service regardless of how you delivered it (i.e., in person or via telehealth).
Vining points out that these parity laws have “opened a major door at the state level for a few forward-thinking PT companies,” but some therapists are still hesitant to incorporate teletherapy because of lingering reimbursement confusion and frequent rule changes.
Other Telehealth Related Legislation
While we’re discussing legal issues, it’s important to note that telehealth laws are very much in flux, and there are many ways to support the expansion of telehealth within our profession. The Center for Connected Health Policy has an up-to-date list of current telehealth legislation as well as a resource detailing telehealth policies in each US state.
Cash-Based Telehealth Considerations
The fluidity and inconsistency of telehealth reimbursement has led many therapists to limit their telehealth offerings to cash-based services—often directed toward a super-niche patient segment. For example, a Colorado-based rock-climbing PT might charge a flat fee to provide a cash-based teletherapy consult for a patient who climbs in Joshua Tree, CA. In this case, as long as the therapist is licensed in California, she is able to treat these patients and receive cash for her services.
Interstate Practice Considerations
Traditionally, PTs wishing to practice teletherapy always had to be licensed in the states where their patients were located. Maintaining licensure in multiple states can be a huge challenge, which has been another barrier to widespread use of telehealth technology. Luckily, we now have The Physical Therapy Compact, which is an agreement among member states to allow cross-state practice by therapists who meet a set of standard requirements. New states are constantly joining, and you can find the most recent information here.
Have you successfully billed for telehealth services in your clinic? Please share your advice in the comment section below!
Meredith Castin, PT, DPT, is the founder of The Non-Clinical PT, a career development resource designed to help physical, occupational, and speech therapy professionals leverage their degrees in non-clinical ways. Meredith is also the co-founder of NewGradPhysicalTherapy and works as a freelance writer and editor for a variety of publications.