CMS is Ending Certain PHE Waivers

Last week, CMS issued guidance for providers pursuant to the announcement on February 9th that the Public Health Emergency (PHE) for COVID-19 will end on May 11, 2023.  They have provided several fact sheets that contain guidance for providers in anticipation of the end of the PHE.  While many of the flexibilities were made permanent, some have been extended through the end of 2023, others are extended through 2024, but some will end on May 11, 2023.       

Some notable services and flexibilities that will end on May 11th include:

  • During the PHE, CMS indicated that a level 1 E/M visit (CPT 99211) could be billed incident to the services of a billing physician or practitioner for a new or established patient when clinical staff assess a patient and collect a specimen for a COVID-19 diagnostic test.  After the PHE, the usual requirements for billing 99211 apply (established patient only).
  • Medicare has been covering a beneficiary’s first COVID-19 test without an order, however after the PHE, Medicare will require an order for all COVID-19 and related testing.
  • During the PHE, virtual check-in services could be provided to both new and established patients (G2010, G2012, G2251, G2252), however at the end of the PHE, these services may only be provided to established patients.
  • National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs) that required an in-person, face-to-face visit for evaluations and assessments had been waived and could be provided via telehealth.  This will expire at the end of the PHE.
  • Physicians will be required to conduct any federally required in-person visits for nursing home residents.
  • Teaching physicians could have virtual presence during the PHE, however after the PHE, teaching physicians only in residency training sites located outside of a metropolitan statistical area may direct, manage, and review care furnished by residents through audio/video real-time communications technology.
  • After the PHE, teaching physicians may bill for levels 4-5 of an office/outpatient E/M visit furnished by residents in a primary care center only when the teaching physician is physically present for the key portion of the service.
  • Specifically for hospitals, there are several waivers that will end that will affect temporary expansion sites, off-site patient screenings, paperwork requirements, provider-based departments, and swing bed services to name a few.
  • CMS has been waiving the Medicare requirement that Critical Access Hospitals (CAHs) limit the number of beds to 25 and length of stay be limited to 96 hours under the Medicare CoPs.  This waiver will terminate at the end of the PHE.
  • Enhanced Medicare payments for new COVID-19 treatments provided during inpatient stays and separate Medicare payments for new COVID-19 treatments provided in outpatient hospital departments will end in May.

We recommend reviewing the fact sheets applicable to your organization in their entirety to identify any areas that require preparation in advance of the end of the PHE.  

We are here to help.  The HBE team is available to assist you with all of your clinical documentation, coding and compliance needs.  We routinely provide compliance partner services to large health systems as well as physician practices. Our services include:

  • Clinical documentation improvement reviews
  • Coding accuracy reviews
  • Policy and procedure development
  • Customized education and training for clinical and administrative staff

For more information, visit our website at:

The Provider Fact Sheets can be accessed here:

The Summary Fact sheet is located here:

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