Medicare Telehealth Flexibilities Impacted by Government Shutdown

As a result of the failure of Congress to pass legislation to extend certain telehealth flexibilities enacted during the COVID-19 pandemic, these benefits have lapsed as of Oct. 1. This means that telehealth use for certain Evaluation and Management (E&M) services is now limited to rural areas as they were before the COVID-19 public health emergency and that patients are not able to receive telehealth services in their homes. In addition, the ability to provide audio-only services to Medicare patients and the Acute Hospital Care at Home program have also lapsed.

Interpretation of imaging studies performed via teleradiology are not impacted. These services are covered by Medicare in accordance with the Medicare Benefit Policy Manual. However, we expect the lapse will impact those in the imaging community who bill E&M, such as interventional radiology, radiation oncology and nuclear medicine.

It is important to note that regulations allowing remote supervision of diagnostic tests (including remote supervision of contrast administration) using audio/video real-time communications technology through Dec. 31, 2025, are not impacted by the government shutdown. The proposal to extend this flexibility permanently will be addressed in the Medicare Physician Fee Schedule final rule.

CMS has instructed providers who choose to perform telehealth services that are not payable by Medicare on or after October 1, to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage. CMS also suggests that providers may wish to hold claims associated with telehealth services pending Congressional action.

CMS notes that the Bipartisan Budget Act of 2018 allows clinicians in applicable Medicare Shared Savings Program Accountable Care Organizations (ACOs) to provide and receive payment for covered telehealth services to certain Medicare beneficiaries without geographic restriction and in the beneficiary’s home. Clinicians in applicable ACOs can provide these covered telehealth services and bill Medicare for the telehealth services that are permissible under Medicare rules during CY 2025, irrespective of further Congressional action.

For questions about the lapse of Medicare telehealth flexibilities, contact Katie Keysor, ACR Senior Director, Economics and Health Policy.