On December 20, 2024, the U.S. House of Representatives overwhelmingly passed the American Relief Act, 2025 (the Act), a short-term spending bill to keep the federal government open through March 14, 2025. The U.S. Senate followed suit shortly thereafter by a vote of 85 to 11 in favor of passage. The Act was signed into law by the president on December 21, 2024.
A Little More Time
According to JDSupra and other news outlets, the Act extends a variety of federal healthcare programs, including the so-called “telehealth flexibilities” from the public health emergency (PHE) era that were set to expire on December 31, 2024. But these extensions were only authorized through the first three months of 2025—that is, through March 31, 2025. Here are a few of the Act’s short-term provisions:
- Removing geographic requirements and expanding originating sites for telehealth services [42 USC § 1395m(m)]
- Telehealth services can be delivered to any location in the U.S., including the home of an individual.
- Expanding practitioners eligible to furnish telehealth services [42 USC § 1395m(m)(4)(E)]
- In addition to physicians, the following types of practitioners are eligible to furnish telehealth services: physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse-midwifes, clinical social workers, clinical psychologists, registered dietitians or nutrition professionals, qualified occupational therapists, qualified physical therapists, qualified speech-language pathologists, and qualified audiologists.
- Extending telehealth services for FQHCs and rural health clinics [42 USC § 1395m(m)(8)(A)]
- Federally qualified health centers and rural health clinics are authorized to provide and reimburse for telehealth services.
- Delaying the in-person requirements under Medicare for mental health services furnished through telehealth [42 USC §§ 1395m(m)(7)(B)(i), 1395m(m)(y)(2), and 1395m(o)(4)(B)]
- Physicians and practitioners are not required to conduct an in-person exam prior to delivering telehealth services for purposes of diagnosis, evaluation, or treatment of a mental health disorder.
- Allowing for the furnishing of audio-only telehealth services [42 USC 1395m(m)(9)]
- Audio-only telehealth services are covered and reimbursable.
- Extending the use of telehealth to conduct face-to-face encounters prior to recertification of eligibility for hospice care [42 USC § 1395f(a)(7)(D)(i)(II)]
- Telehealth encounters prior to recertification of eligibility for hospice care are covered and reimbursable.
While these extensions will no doubt be welcomed by telehealth providers and patients across the nation, they are pared down from the broader protections contained in earlier versions of the Act. For example, Congress had negotiated a funding bill that would have extended telehealth flexibilities through December 31, 2026, but support for this iteration of the bill faltered.
In addition, the Act did not extend other flexibilities to the dismay of some. For example, the Act did not cover first-dollar coverage of high deductible health plans health savings accounts (HDHP-HSA) for telehealth services, a measure that protects consumers from high out-of-pocket costs for such services. The Act also did not cover cardiopulmonary rehabilitation services via telehealth.
Coding Issues
According to the Centers for Medicare and Medicaid Services (CMS), Medicare will not be utilizing the new codes created within the audio-video code set. Providers are instead expected to continue to utilize the evaluation and management (E/M) codes for these telehealth services, as if they were conducted face to face.
When coding telehealth visits through March 31, 2025, here are some things to remember:
- According to updates for 2025, audio-only telehealth visits should be coded using the new CPT codes 98008-98015 for both new and established patients (see below chart), replacing the old telephone-only codes 99441-99443, which are being deleted.
- These new codes specifically designate audio-only telehealth encounters and should be utilized when a patient is unable or unwilling to use video technology while the provider can access such technology.
According to observers within the healthcare sector, telehealth flexibilities enjoy broad bipartisan support in Congress, and many expect them to be made permanent or extended again prior to their March 31 expiration. So, we may need to revisit this topic within the next 90 days.