CMS Exempts Small Practices from Quality Reporting, Expands Tele-Psychotherapy

Seema Verma, administrator of Centers for Medicare & Medicaid Services.
Copyright ©2016 GreatAgain.gov, CC BY 4.0

In June, we let you know that Centers for Medicare and Medicaid Services planned to exempt some small behavioral health practices from grueling and expensive quality reporting requirements in a proposed rule.

Now, CMS has finalized that rule. And not only does it exempt many small therapy practices from quality reporting, it also expands the telehealth services Medicare and Medicaid will reimburse you for!

Read on for a quick rundown of what practices are exempt from quality reporting and what psychotherapy telehealth services are now covered:

What practices are exempt from quality reporting?

In the final rule, practices with “less than or equal to $90,000 in Medicare Part B allowed charges or less than or equal to 200 Medicare Part B patients” are exempt from participating in quality reporting. About 934,000 providers fit those criteria. Yours may be one of them!

If you fit those requirements, you are still allowed to participate in quality reporting. And doing so does give you a chance to receive increased reimbursements from Medicare and Medicaid. But participating in quality reporting isn’t easy or cheap.

For more details on quality reporting, see our previous blog post.

What new psychotherapy telehealth services will be covered?

With the final rule, Medicare and Medicaid will reimburse you for performing psychotherapy with a client in crisis over a telehealth channel (CPT codes 90839 and 90840). According to the American Psychological Association, the client must be in “high distress with complex or life threatening circumstances that require the psychologist’s urgent and immediate attention” for these codes to be used.

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This seems like an especially appropriate use of telehealth. After all, circumstances of a client’s crisis may not permit them to travel to your office or for you to reach them. So if you need to conduct psychotherapy remotely for the client’s safety, you may do so with more confidence that Medicare or Medicaid will reimburse you for your services.

When does this rule take effect?

This rule takes effect January 1, 2018.