The Centers for Medicare and Medicaid Services (CMS) provides proper guidelines for billing telehealth CPT codes and 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 CPT codes for medical billing guidelines
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.
What should you look for when applying Telehealth CPT Codes?
To ensure that healthcare providers are appropriately reimbursed for telehealth services, using the correct Current Procedural Terminology (CPT) codes when billing insurance companies is important. Here are some important things to note when using telehealth CPT codes:
Choose the correct code:
Several CPT codes are specifically designated for telehealth services, such as 99201-99215 for evaluation and management services, 99421-99423 for online digital evaluation and management services, and 99441-99443 for telephone evaluation and management services. Be sure to choose the code that best describes the service provided.
Document the telehealth visit:
Just like an in-person visit, it is important to document it thoroughly. This includes the reason for the visit, the patient’s medical history and current medications, and any diagnoses or treatment plans discussed. Be sure also to document that the visit was conducted via telehealth and the platform used.
Use the appropriate modifier:
When billing for telehealth services, it is important to use the appropriate modifier to indicate that the service was provided via telehealth. The most commonly used modifiers are GT (via interactive audio and video telecommunications systems) and GQ (via asynchronous telecommunications systems).
Verify insurance coverage:
Before providing telehealth services, be sure to verify that the patient’s insurance plan covers telehealth services and what the reimbursement rates are for each CPT code. This can help avoid billing errors and ensure that the provider is reimbursed appropriately.
Follow state and federal regulations:
Telehealth regulations vary by state and are subject to federal guidelines, so it is important to know any applicable regulations when providing telehealth services. This includes ensuring that the provider is licensed in the patient state and location and that the telehealth platform used meets HIPAA requirements.
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.