Rehab Therapy Telehealth Takeaways from the 2023 Final Rule

The 2023 final rule didn’t give rehab therapists much in the way of clarity when it comes to the long-term future of telehealth as a reimbursable service. But, it did present a path forward—if therapists are willing to take it. Here’s where rehab therapy telehealth stands in 2023, and how it can become a permanent addition in the future.   

What’s the status of telehealth for CY 2023?

In the final rule, CMS reaffirmed that PT and OT telehealth privileges will go away 151 days after the expiration of the public health emergency (PHE). With the PHE slated to expire on January 11, 2023, that means that telehealth services would no longer be reimbursable for rehab therapists after June 11, 2023 (barring another extension of the PHE). 

What makes it slightly confusing is CMS’ declaration that telehealth will remain available for PTs and OTs use throughout CY 2023—just not as a reimbursable service under Medicare after June 11. So providers continuing to use telehealth CPT codes past that date shouldn’t expect to be reimbursed for those services.    

CMS also noted in its own final rule summary that for 2023, clinicians “should continue billing telehealth claims with the place of service indicator you would bill for an in-person visit.” CMS goes on to state that clinicians must use modifier 95 with telehealth services through the end of CY 2023, or the end of the year in which the PHE ends.

For reference, here are the CPT codes available to use for telehealth services through CY 2023: 

Why are rehab therapy telehealth services still a temporary privilege?

As we noted in our final rule breakdown, telehealth remains a Category 3 service for rehab therapists. But what is Category 3, exactly? Here’s how CMS describes in in the 2023 final rule: 

“In the CY 2021 PFS final rule (85 FR 84507), we created a third category of criteria for

adding services to the Medicare Telehealth Services List on a temporary basis following the end

of the PHE for the COVID-19 pandemic: Category 3. This new category describes services that

were added to the Medicare Telehealth Services List during the PHE for which there is likely to

be clinical benefit when furnished via telehealth, but there is not yet sufficient evidence available

to consider the services for permanent addition under the Category 1 or Category 2 criteria.”

In order to be considered for addition to the list of permanent telehealth providers, PT and OT telehealth services need to meet the criteria of Category 1 or Category 2 services. According to the CMS website, Category 1 services are “similar to professional consultations, office visits, and office psychiatry services that are currently on the list of telehealth services.” In considering Category 1 requests, CMS looks at the similarities between the suggested service and existing telehealth services to see if it fits within the framework of available technology.   

Category 2 services are those not similar to current permanent telehealth services. In the case of Category 2 suggestions, CMS is largely focused on whether the service produces a “demonstrable clinical benefit” to patients, which include: 

• diagnosis and treatment for populations without sufficient access to in-person options for either;
• a reduced rate of complications;
• decreased future interventions;
• decreased future hospitalizations;
• faster resolution to treatments;
• decreased pain or bleeding; and
• reduced recovery time.  

What’s next for rehab therapy telehealth?

The future of telehealth for rehab therapists remains very much up in the air. But this doesn’t have to be a “wait and see” situation; instead, rehab therapists need to take a “make it happen” approach and take advantage of the options at their disposal to make telehealth a permanent addition to the profession. 

Rehab therapists need to advocate for telehealth legislation.

In order to keep the telehealth privileges that so many clinicians have made use of during the pandemic, rehab therapists can (and should) lobby legislators to add PTs, OTs, and SLPs to the list of eligible telehealth providers. There are a couple of measures currently in play: 

• The Advancing Telehealth Beyond COVID-19 Act of 2022 would extend telehealth privileges for PTs, OTs, and SLPs through the end of 2024, should the PHE end before then. That bill was passed by the House in July 2022 and referred to the Senate.    
• The Expanded Telehealth Access Act would allow PTs, OTs, and SLPs to be added to the list of permanent telehealth providers. At the moment, the bill is stuck in the House Subcommittee on Health. 

If you want to add your voice to those pushing for these bills, you can check out the advocacy resources offered by the APTA, APTQI, AOTA, and ASHA.  

Providers need to collect data to prove the benefits of telehealth. 

Passing the Expanded Telehealth Access Act would be a great first step for rehab therapists, but it’s only part of the solution. As noted in this blog post, it would still be up to CMS to actually add PTs, OTs, and SLPs onto the list of telehealth providers once they’re permitted to do so. 

Convincing CMS to place telehealth into Category 1 or Category 2 for rehab therapy will require PTs and OTs to collect the data that shows they are meeting the criteria for either category. That means better outcomes tracking, and making use of remote therapeutic monitoring as a tool to improve remote care while also collecting the data that’s needed. 

We need states to change practice acts, too. 

If getting a bill through Congress isn’t enough, there’s state legislation to consider as well. Thanks to the intricacies of federalism, passage of the Expanded Telehealth Access Act and the addition of PTs, OTs, and SLPs to the Medicare Telehealth Provider List wouldn’t change what’s in your respective state practice act—which means that many providers might still be unable to use telehealth. 

Fortunately, you can work to change those regulations as well with a little additional advocacy; as laid out in this post on telehealth advocacy, you’ll need to work with the local chapter of your professional advocacy group, which will have a better grasp of the processes and key players in your state than the national organization. For easy reference, here are the listings for the APTA chapters and Sections, AOTA state associations, and ASHA state-by-state contacts.    

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The 2023 final rule gave us more temporary, ad hoc telehealth regulations that aren’t doing much to help providers or patients move forward with what has shown to be a beneficial mode of treatment. With a bit of work, 2023 can be the year that rehab therapists score some telehealth wins with both CMS and lawmakers.