Renee Kinder

Ap·pen·dix — a section or table of additional matter at the end of a book or document

Do you generally refer to the appendix in your manuals, research materials, or other clinical practice guidelines? 

Perhaps when a question arises or context references you to the appendix, however not generally without being directed to do so?

Today, I hope you gain an appreciation of the additional appendices provided to us within Current Procedural Terminology (CPT®) impact the evolution of telehealth allowances. 

And Merriam-Webster suggests that appendices should be used when referring to texts, and appendixes for non-textual things… hoping you agree with my pluralization decision here, but on to the point. 

Let us begin with our current state and access to telehealth. 

Therapists across the nation have seen the benefits of telehealth service allowances since the initial Centers for Medicare & Medicaid Services announcement of the telehealth expansion in an April 30, 2020, press release and its COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers.

This response to the spread of COVID-19 from CMS allowed occupational therapists (OTs), physical therapists (PTs), and speech-language pathologists (SLPs) to provide select telehealth services to Medicare Part B (outpatient) beneficiaries for the duration of the federally-declared public health emergency (PHE). 

The original expansion included a limited set of telehealth services. 

CMS subsequently expanded the list of Current Procedural Terminology (CPT) codes on March 30, 2021, resulting in a more comprehensive list of eligible telehealth services provided by therapists.

So, what happens at the end of the PHE?

We know that access to our patients via alternative means is beneficial well beyond the pandemic.

Telehealth allows us to reach individuals more effectively in rural communities.

We can more holistically care for those with chronic conditions which research showing that approximately 21.4 million Medicare beneficiaries had at least two chronic conditions and accounted for the bulk of healthcare services provided under Medicare.

And finally, telehealth services allow for more effective transitions into the home and other least restrictive environments therefore honoring quality of life and choice for those we serve. 

Naturally advocacy efforts are in the works on behalf of our professional societies in the American Speech Language Hearing Association, American Occupational Therapy Association, and American Physical Therapy Association to encourage appropriate access in the future. 

But what is the plan beyond advocacy?

How will the future of CPT coding promote access to criteria associated with telehealth? 

You may be surprised to learn much of this is already in the works and currently defined in your handy CPT manual under Appendix P and T. 

Yes, this is a time when review of the Appendix matters!

How are these areas defined, you ask?

Appendix P: CPT Codes That May Be Used For Synchronous Telemedicine Services

Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified healthcare professional and a patient who is located away at a distant site from the physician or other qualified health care professional. 

Modifier 95 may only be appended to the services listed in Appendix P.

Appendix P is the list of CPT codes for services that are typically performed face-to-face but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.

A 2020 resource published by the American Medical Association outlines the dynamic between CPT codes that meet the criteria for Appendix P, versus are allowable during the PHE alone.

Providers should review most current coding resources to remain knowledgeable on allowances and impacts on clinical practice one we near the end of the PHE.

Appendix T: CPT Codes That May Be Used For Synchronous Real-Time Interactive Audio-Only Telemedicine Services

During the February 2022 meeting, the CPT® Editorial Panel accepted the addition of Appendix T

This appendix is a listing of CPT codes that may be used for reporting audio-only services when appended with Modifier 93. Procedures on this list involve electronic communication using interactive telecommunications equipment that includes, at a minimum, audio. 

The codes listed in Appendix T will be identified with an audio speaker symbol in the 2022 code set. The list of codes contained in the appendix, used with Modifier 93, is effective April 1, 2022.

Modifier 93 descriptor: Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system.

Additional criteria to consider: The totality of the communication of information exchanged between the physician or other qualified healthcare professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

In closing, now more than ever now is the time to stay informed on coding criteria, changes, and most importantly, the impact of access to those we serve daily. 

Flip beyond the content, dig deep, and remember the appendices matter. 

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected]

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.