telemedicine

Guidelines for Telemedicine Codes

Note: The following information relates to the provisions of the 1135 waiver during the Coronavirus (COVID-19) Public Health Emergency (PHE) which went into effect on March 6, 2020.

There are three groups of telemedicine codes:

  • TELEHEALTH VISITS:telemedicine coding

    Interactive audio and video telecommunications system that permits real-time communication between physician or other qualified healthcare professional at the distant site, and the beneficiary at the originating site.

  • For new or established patients;
  • Medical Billing for Telehealth visits take the place of E/M visits at the provider’s office, nursing facility or hospital.
    1. Which procedure codes? All CPT and HCPCS codes in Appendix P of the CPT manual, including: (for the complete list of allowable codes, see: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes)
      1. 99201-99205, Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components…
      2. 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components…
      3. 99241-99245, Office consultation for a new or established patient, which requires these 3 key components…
      4. 90832-90834 and 90836-90838, Individual psychotherapy
      5. 90791 and 90792, Psychiatric diagnostic interview examination
      6. 99354 and 99355, Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service…
    2. POS: Use place of service (POS) 02
    3. Modifiers:
      1. Medicare: Modifier 95: indicates telemedicine service via a real-time interactive audio and video telecommunication, for services listed in Appendix P (Medicare is only accepting modifier GT on institutional claims from practitioners billing under the CAH Optional Payment Method II);
      2. BCBS and UHC accept two different modifiers:
        1. Modifier 95: Description as above;
        2. Modifier GT: Via interactive audio and video telecommunications systems:  This is not to be mistaken for asynchronous services (which is not accepted by BCBS).
  • VIRTUAL CHECK-INS:virtual visit

    Brief communication initiated by patient using a broader range of communication methods.

  • POS: Regular place of service that would be billed for in-person visit;
  • Quick communication (e.g., to determine if the patient needs to be seen in person);
  • For patients with an established relationship with provider where the communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours;
  • Practitioners may respond to inquiry initiated by patient via phone, audio/visit, secure text messages, email;
  • Practitioners must have E/M in their scope of practice, including: physicians, nurse practitioners, PAs.

Physicians or practitioners can bill the following HCPCS codes:

  1. HCPCS code G2012: The provider spends 5 to 10 minutes by audio-only real-time (telephone or other synchronous, two-way audio) interactions with an established patient. The provider must be a physician or other healthcare professional who is qualified to report an E/M service;
  2. HCPCS code G2010: The provider receives captured recorded video and/or images remotely from a patient. He evaluates the material received, analyzes it, and interprets the findings and follows up with the patient within 24 hours (via phone, email, text messaging, etc., which may be real-time or asynchronous).
  • E-VISITS:

    Online digital evaluation and management (E/M) services are patient-initiated services with physicians or other qualified health care professionals (QHPs). Requires physician or other QHP’s evaluation, assessment, and management of the patient.

    • POS: Regular place of service that would be billed for in-person visit;
    • For patients with an established relationship with provider;
    • Not related to a medical visit within the previous 7 days and not resulting in a medical visit within the next 24 hours;
    • Communication via online patient portals;
    • During the encounter, responds to the patient’s health concerns, answers any medical questions, and recommends management;
    • Practitioners may include: physicians, nurse practitioners, PAs, LCSWs, clinical psychologists;
    • Report this code for (see below) minutes of cumulative time spent in communication with the patient over a 7–day period.

Practitioners who may independently bill Medicare for evaluation and management visits (for instance, physicians and nurse practitioners) can bill the following codes:

    1. 99421: covers 5 to 10 minutes of cumulative time;
    2. 99422: covers 11 to 20 minutes of cumulative time;
    3. 99423: covers 21 or more minutes of cumulative time.

Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes:

    1. G2061: covers 5 to 10 minutes of cumulative time;
    2. G2062: covers 11 to 20 minutes of cumulative time;
    3. G2063: covers 21 or more minutes of cumulative time.

Specific telemedicine information from CMS during the COVID-19 Public Health Emergency can be found at:

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

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