PTs Seek Medicare Coverage for Telehealth During the Pandemic

Many healthcare providers are expanding their telehealth services during the Coronavirus epidemic, thanks in large part to relaxed guidelines for Medicare coverage. But physical and occupational therapists and speech and language pathologists aren’t enjoying those advantages.

(For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.)

At this time, the use of connected health platforms to deliver those services isn’t covered by Medicare, even though language had been included in the Coronavirus Aid, Relief and Economic Security (CARES) Act that was passed into law last month. 

“It’s very frustrating,” says Daniel Seidler, a long-time physical therapist who now runs TelePT Solutions, a consulting firm helping PT practices use telehealth. “We’re struggling right now.”

When the CARES Act was passed, PT, OT and SLP services were included as authorized services under Medicare, with the appropriate codes for telehealth reimbursement. But the therapists providing those services were not classified as eligible distant site providers, and while the Centers for Medicare & Medicaid Services was given the authority to waive that restriction, the agency hasn’t done so.

“Why are (the codes) in there if we can’t use them?” Seidler asks.

The lack of clarity is especially troublesome during the COVID-19 emergency. Many small and independent therapists have been forced to shut their doors and lay off staff because they can’t see their patients under quarantine guidelines enacted by many states. Telehealth would allow them to stay open and treat patients through virtual care – if they could be assured of Medicare coverage.

“Telehealth is a very effective means of delivering PT,” Seidler says. “Studies have shown for years that many of the most effective techniques for treating many physical conditions don’t involve physical contact with the patient. Knowledge, problem solving abilities, communication and compassion are the most valuable attributes of an effective PT.”

While therapy services have in the past been included in bundled payment programs, as well as post-discharge and home-based care services covered by some Medicaid and private payer programs, CMS hasn’t included that coverage in Medicare, whose members comprise the biggest population served by these programs (either through Medicare or private plans that follow Medicare guidelines).

“Right now (patients) are stuck at home and probably not as active as they should be,” Seidler points out. “Now is the time when they really need” these services.

With the understanding that CMS has added new telehealth coverage and amended its policies more than once during the pandemic, representatives of the American Physical Therapy Association met with federal officials earlier this week to discuss approving the waiver and making PTs, OTs and SLPs authorized Medicare telehealth providers.

“You know, the whole point is to try to keep people active and safe and healthy, and they’re not able to do that if they cannot receive the medically necessary physical therapy services via telehealth,” Kara Gainer, APTA’s Director of Regulatory Affairs, recently told Texas-based KSAT News.

Seidler says the talks went well.  But they’re still waiting for additional guidance.

Meanwhile, other providers are adopting telehealth programs and trying new tools and services under the temporary guidelines enacted by state and federal officials. And they’re gathering data and public support for those services, in hopes of convincing the states and federal government to relax the rules for good, once the emergency is over.

“We should be doing that too,” says Seidler. “This is a moment to shine. We should be able to show that telehealth is an effective way of treating our patients.”