Mistakes that Providers Make While Using CPT Codes for Medicare Telehealth Reimbursement

The Centers for Medicare and Medicaid Services (CMS) provides proper guidelines for billing telehealth services by using specific reporting terminologies.

Decoding these terminologies is challenging not only for providers but originating sites that ensure eligibility and complete Medicare telehealth reimbursement.

According to the guidelines shared by CMS, telehealth services are subject to be provided using an internet-based telecommunication system with interactive audio and video which enables direct communication between beneficiary and provider. In the CMS telemedicine demonstration program, the exceptions of asynchronous technology in Hawaii and Alaska that are defined as the transfer of medical information and reviewed by practitioners are permitted.

The place where the transmission of services to the beneficiary takes place is an originating site. Medicare would cover the telehealth service if the originating site is;

  • Hospital
  • Practice office
  • Rural health clinic
  • Skilled nursing facility
  • Renal dialysis center
  • Critical Access hospitals (CAHs)
  • Federally qualified health centers (FQHCs)
  • Community mental health centers
  • A jurisdiction outside Metropolitan Statistical Area (MSA)
Medicare telehealth billing guidelines
source:forbes.com

A distant site is a location where the services from the provider are delivered. Providers from distant sites and centers eligible to obtain payments from Medicare telehealth reimbursements include;

  • Nurse practitioners
  • Physicians
  • Nurse-midwives
  • Physician assistants
  • Certified anesthetics
  • Clinical nurse specialists
  • Nutrition professionals
  • Registered dietitians

Medicare telehealth billing guidelines

If telehealth services are not delivered according to the requirement mentioned above and according to the site and equipment, telehealth services cannot be reimbursed.

Also, if a provider renders telehealth services to a beneficiary at a site that is not eligible for Medicare reimbursement, then the services will not be billable or payable. (For instance, visit a beneficiary in a provider’s office that does not meet Medicare guidelines).

This is essential to understand that not all practices and services are not eligible to be paid by Medicare telehealth reimbursements. For CY 2018, 96 Current Procedural Terminology-CPT and Health Common Procedure Coding System (HCPCS) codes are designated for different services.

In addition, claims should be submitted according to eligible distant location and origin site requirements mentioning applicable and correct HCPCS and CPT codes.

CPT codes for Medicare telehealth reimbursement

Remote Patient Monitoring CPT Codes
Telehealth Visits
99201 – 99215 Office or other outpatient visits. New and established patients.
G0425 – G0427 Consultations, emergency department, or initial inpatient. New and established patients.
Virtual Check-ins
G2010 Remote evaluation of recorded video and/or images submitted by an established patient (for example, store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. Established patient.
G2012 Brief communication technology-based service by a physician or other qualified healthcare professional who can report evaluation and management services, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion. Established patient.
G2252 Brief communication technology-based service by a physician or other qualified the healthcare professional who can report evaluation and management services, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion. Established patient.
Virtual Check-Ins (For providers who cannot independently bill for E/M services)
G2250 Remote assessment of recorded video and/or images submitted by an established patient (for example, store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment. Established patient
G2251 Brief communication technology-based service by a qualified health care professional who cannot report evaluation and management services, not originating from a related E/M service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion. Established patient.
Virtual Visit
99421 –99423 Online digital evaluation and management service, for up to 7 days, a cumulative time during the 7 days. Established patient.
G2061 – G2063 Online assessment by qualified non-physician healthcare professional. Established patient.
Telephone Services
99441 –99443 Evaluation and management by a physician or other qualified health care professional who may report evaluation and management services provided to a patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. Established patient.
Interprofessional Telephone/Internet/Electronic Health Record Consultation
99446 – 99449 Assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified healthcare professional.

*Each code includes time for medical consultative discussion and review

99451 Assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time.

99452 Referral service(s) provided by a treating/ requesting physician or other qualified healthcare professional, 30 minutes.

Telemedicine Services
G0406-G0408 Follow-up inpatient consultation via telehealth. Established patient.
G0425-G0427 Telehealth consultation, emergency department. New patient.
G0508, G0509 Telehealth consultation, critical care. New and established patients.

Ending notes

A provider can be reimbursed efficiently for the services rendered if they avoid making mistakes in reimbursement claims such as not using correct/applicable billing codes, not focusing on maintaining post-visitation documentation, not training practice staff according to the telehealth billing process, and in some cases, not outsourcing billing service. Ensuring that claims are according to provided guidelines will reduce the delay in Medicare telehealth reimbursement and help improve revenue cycle management.