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.

Updated: April 10, 2020

There are four groups of telemedicine codes:

TELEHEALTH VISITS:

Use of interactive audio and video telecommunications system that permits real-time communication between physician or other qualified healthcare professional and the patient at a remote site.

  • For new or established patients at any location (including place of residence);
  • Medical Billing for Telehealth visits take the place of E/M and similar services at the provider’s office, nursing facility or hospital.
  1. Which procedure codes? The following is a partial list of services that are eligible to be billed as telehealth services. CMS has expanded the list of allowable telehealth codes during the public health emergency (PHE), which can be found at: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
    • 99201-99205, Office or other outpatient visit for the evaluation and management of a new patient…
    • 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient…telemedicine coding
    • 99241-99245, Office consultation for a new or established patient, which requires these 3 key components…
    • 90832-90834 and 90836-90838, Individual psychotherapy…
    • 90791 and 90792, Psychiatric diagnostic interview examination…
    • 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 the place of service (POS) that would be normally used for an in-person visit.
  3. Modifiers: Use Modifier 95.
  • E/M level: During the PHE, E/M level is determined based on either the MDM complexity alone or the time alone. Time is defined as total time spent by the practitioner on the day of encounter (including face-to-face and non-face-to-face time). See Table 1 for the MDM complexity and times associated with the E/M levels.  During the PHE, the history or examination elements will not be used to determine the E/M level.  In addition, requirements pertaining to counseling and/or care coordination for time-based codes, will be waived during the PHE.

Table 1:   MDM Complexity and Time Requirements for Office E&M Levels During the PHE

  • MDM Complexity and Time Requirements for Office E&M Levels
    Table 1: MDM Complexity and Time Requirements for Office E&M Levels During the PHE

    *E/M typical times published by CMS: https://www.govinfo.gov/content/pkg/FR-2019-11-15/pdf/2019-24086.pdf
    (in Table 35).

     

    TELEPHONE ONLY SERVICES:

    Evaluation and management or evaluation and assessment services by telephone only (no video component).

    • For new or established patients at any location (including place of residence);
    • Communication is not related to an E/M visit within the previous 7 days and does not lead to an E/M visit within the next 24 hours;
    • Evaluation and management: Practitioners who may independently bill for evaluation and management visits (i.e., physicians, PAs and nurse practitioners), may bill the following codes:
      1. 99441: 5 to 10 minutes of medical discussion;
      2. 99442: 11 to 20 minutes of medical discussion;
      3. 99443: 21 to 30 minutes of medical discussion;
    • Evaluation and assessment: Clinicians who may not independently bill for evaluation and management visits (i.e., physical therapists, occupational therapists, speech language pathologists, clinical psychologists), may bill the following codes:
      1. 98966: 5 to 10 minutes of medical discussion;
      2. 98967: 11 to 20 minutes of medical discussion;
      3. 98968: 21 to 30 minutes of medical discussion;
    • POS: Use the place of service (POS) that would be normally used for an in-person visit. No modifiers required.

    VIRTUAL CHECK-INS:

    virtual visitBrief communication initiated by patient using a broader range of communication methods.

    • Quick communication (e.g., to determine if the patient needs to be seen in-person);
    • For new or established patients at any location (including place of residence);
    • Communication is not related to an E/M visit within the previous 7 days and does not lead to an E/M visit within the next 24 hours;
    • Practitioners who have E/M in their scope of practice, (i.e., physicians, nurse practitioners, PAs), may bill the following 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.
      1. 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).
    • POS: Use the place of service (POS) that would be normally used for an in-person visit. No modifiers required.

    E-VISITS:

    Patient-initiated online digital communication with physicians or other qualified health care professionals (QHPs).

    • Communication via online patient portals or secure email. Provider responds to the patient’s health concerns, answers any medical questions, and recommends management;
    • For new or established patients at any location (including place of residence);
    • Do not report on a day when the physician or other qualified health care professional reports E/M services (including telehealth E/M services);
    • Practitioners who may independently bill for evaluation and management visits (i.e., physicians, PAs and nurse practitioners), may bill the following codes. The times below represent cumulative time spent in communication with the patient over a 7-day period:
      1. 99421: 5 to 10 minutes of cumulative time;
      2. 99422: 11 to 20 minutes of cumulative time;
      3. 99423: 21 or more minutes of cumulative time.
    • Clinicians who may not independently bill for evaluation and management visits (i.e., physical therapists, occupational therapists, speech language pathologists, clinical psychologists), may bill the following codes. The times below represent cumulative time spent in communication with the patient over a 7-day period:
      1. G2061: 5 to 10 minutes of cumulative time;
      2. G2062: 11 to 20 minutes of cumulative time;
      3. G2063: 21 or more minutes of cumulative time.
    • POS: Use the place of service (POS) that would be normally used for an in-person visit. No modifiers required.

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

    https://www.cms.gov/files/document/covid-final-ifc.pdf

    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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