February 28, 2025

Below is a follow up to the message on this topic that was sent earlier this week.

Thanks to all of you who contacted your members of Congress (150 and counting)! This is the best way to confirm continuation of Medicare coverage. Please continue to send messages if you have not done so.

As was noted in the first post, there are differing opinions on whether Medicare telemental health is already covered. CSWA is taking a conservative approach and making sure that members of Congress have this on their radar, regardless.

Another issue which some members raised was the concern about seeing patients once every six or twelve months in-person. There is a way to avoid this in CMS Calendar Year (CY) 2023 Centers for Medicare and Medicaid (CMS) Physician Fee Schedule, page 69464, which reads as follows:

Are there exceptions for the subsequent in-person visit every 12 months?

Yes, for both established and new patients. In the CY 2022 CMS PFS final rule CMS stated: “Specifically, if the patient and practitioner agree that the benefits of an in-person, non-telehealth service within 12 months of the mental health telehealth service are outweighed by risks and burdens associated with an in-person service, and the basis for that decision is documented in the patient’s medical record, the in-person visit requirement will not apply for that particular 12-month period. For example, situations in which the risks and burdens associated with an in-person service may outweigh the benefit could include, but are not limited to, instances when an in-person service is likely to cause disruption in service delivery or has the potential to worsen the patient’s condition(s). The risks and burdens associated with an in-person service could also outweigh the benefit if a patient is in partial or full remission and only requires a maintenance level of care. Other examples of such instances may include the clinician’s professional judgment that the patient is clinically stable and/or that an in-person visit has the risk of worsening the patient’s condition, creating undue hardship on self or family, or if it is determined that the patient is at risk for disengagement with care that has been effective in managing the illness. Practitioners must also document that the patient has the ability to obtain any needed point of care testing, including vital sign monitoring and laboratory studies. Practitioners must note the exception for any applicable 12-month interval.”

This exception should allow LCSWs to claim it would be detrimental to treatment goals if a patient was required to come see the therapist in person. Be sure to document this in the Medical Record.

As always, please let Laura know if you have any questions and when you have sent messages to Congress by emailing her at lwgroshong@clinicalsocialworkassociation.org.