Billing FAQs

Telehealth refers to the delivery of clinical services from a distance. The practice of telehealth largely breaks down into three types of solutions, store-and-forward, remote patient monitoring, and real-time tele encounters.

Interactive – real-time audio/visual (Mostly used)

Store and Forward – asynchronous: Primary Care Providers share patient medical information like lab reports, imaging studies, videos, and other records with another physician, radiologist, or specialist at another location.

Remote Patient Monitoring – (Specialists tracking a patient’s vital signs and activities from at a distance. It is used for high-risk patients, like those with heart conditions and people who have recently been released from the hospital.

• Physicians
• Nurse Practitioners
• Physician Assistants
• Nurse-midwives
• Clinical Nurse Specialists
• Certified Registered Nurse Anaesthetists
• Clinical psychologists and social workers*
• Registered dietitians or nutrition professional

Under the 1135 waiver, effective for services starting March 6, 2020, and for the duration of the COVID-19 Public Health Emergency, Medicare will make payments for Medicare telehealth services rendered to patients in broader circumstances.

Medicare will make payments for professional services rendered to beneficiaries in all areas of the country in all settings. The requirements regarding the ‘originating and distant’ site have been waived during this period.

Under the waiver, eligibility limitations on Medicare patients are to be removed during the emergency. In particular, patients outside of rural areas, and patients in their homes will be eligible for telehealth services, effective March 6, 2020.

The following CMS list highlights all services that  may be performed via telemedicine.

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.

These services are described by HCPCS codes and paid under the Physician Fee Schedule. Under the emergency declaration and waivers, these services may be provided to patients by professionals regardless of a patient’s location.

• Physician interpretation of diagnostic tests,
• Evisits
• Virtual check-ins

Section 1135(g)(3)) requires that the patient must have a prior established relationship with a practitioner, HHS will NOT conduct audits for prior relationship for claims submitted during this public health emergency.

Currently, CMS allows the use of telecommunications technologies that have audio and video capabilities that are used for two-way, real-time, interactive communication.

Generally, it depends on whether the practice wants to record or not . Reimbursement is always based on documentation for medically necessary services, so accurate documentation is recommended to avoid future issues Recordings are expensive but can help with future audits.

Yes, during COVID-19 emergency providers are allowed to see out-of-state patients.

Yes, verbal consent is required from the patient.

No, CMS has relaxed the HIPAA rules during the emergency.

Yes. The waiver temporarily eliminates the requirement that the originating site must be a physician’s office or other authorized healthcare facility and allows Medicare to pay for telehealth services even when beneficiaries are at their homes or any other care setting .

G0425-G0427 –Emergency department consultations G0406-G0408 –Hospital or SNFs consults G0442-G0447 –Alcohol screenings 99406-99407 – smoking cessation 96160-96161 – Health Risk Assessments 97802 -97804 – Medical Nutrition 90832 – 90838 – Psytx pt&/fam 99201-99215 – Office E & M 99231-99233 – Hospital Follow-Ups (1 every 3 days) 99307-99310 – SNF visits (limited to 1 every 30 days) 90791- 90792 -Psych evaluation 90845 – 90846 – Family psytx 90951 – 90970 – Esrd home pt serv

CMS is not requiring additional or different modifiers associated with telehealth services rendered under these waivers. However, consistent with current rules, there are three scenarios where modifiers are required on Medicare telehealth claims:

First, when a telehealth service is rendered via asynchronous (store and forward) technology as part of a federal telehealth demonstration project in Alaska and Hawaii, the GQ modifier is required;

Second, when a telehealth service is billed under CAH Method II, the GT modifier is required;

Finally, when telehealth service is rendered for purposes of diagnosis and treatment of an acute stroke, the G0 modifier is required.

Currently, there are no specific ICD-10 codes to use when billing for services related to COVID-19. The CDC has provided the following coding guidelines for COVID-19.

No, they are not the same.

Telehealth services require both audio and video connection between the provider and the patient.

Telephonic assessment services require only an audio connection between the provider and the patient.

Telephonic codes: 99441 (5 to 10 mins.), 99442(11 to 20 mins.), 99443 (21 to 30 mins.), and for Medicare patients – G2012 (5 to 10 mins.)

The HCFA 1500 should reflect the Place of Service (POS) code 02-Telehealth, to indicate that the billed service was rendered at a professional telehealth service site.

GT: used to indicate a service was rendered via synchronous telecommunication.

GQ: used to indicate a service that was delivered via an asynchronous telecommunications system.

95: Synchronous Telemedicine Service rendered via real-time interactive audio and video telecommunications system.

Medicare pays the same amount for telehealth services as it would if the services were rendered in person.

Medicare uses the facility payment rate when services are rendered via telehealth.

Yes, Medicare advantage plans are required to cover all services which are covered by Medicare.

However, telemedicine services eligibility vary for commercial payers .

Yes, the use of telehealth does not change the out of pocket costs for beneficiaries of Medicare. Beneficiaries are generally liable for their deductible and coinsurance; however, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

Copays and deductibles for telemedicine vary for commercial payers

The telehealth waiver will be effective until the Public Health Emergency declared by the Secretary of Health & Human Services ends.

A virtual check-in pays professionals for brief (5 to 10 min) communication that mitigates the need for an in-person visit, whereas a visit rendered via telehealth is treated the same as an in-person visit, and can be billed using the code for that service, using the place of service 02 code to indicate that the service was performed via telehealth.

An e-visit is when a beneficiary communicates with their doctors through online patient portals. But many people are using this word for telemedicine visits as well.

No. The statutory provision broadens telehealth flexibility without regard to the diagnosis of the patient.

In all areas (not just rural), established Medicare patients in their home may have brief communications with practitioners via different technology methods, including synchronous discussion over a telephone or exchange of information through video or image.

These virtual check-ins are for patients with an established (or existing) relationship with a physician or certain practitioners 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 (or soonest appointment available). The patient must verbally consent to receive virtual check-in services.

Yes, Medicare coinsurance and deductibles would generally apply to these services.

HCPCS code G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, 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.

HCPCS code G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., 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.

Patients communicate with their doctors without going to the doctor’s office by using online patient portals.

These services can only be reported when the billing practice has an established relationship with the patient.

Individual services need to be initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation. 

This is not limited to only rural settings. There are no geographic or location restrictions for these visits.

The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable.

Yes, Medicare coinsurance and deductibles would generally apply to these services.

Summary of Medicare Telemedicine Services

Medicare fee schedule for covered Telemedicine services

Code	Short Descriptor	National Fee	Code	Short Descriptor	National Fee
90785	Psytx complex interactive	$14.07	99214	Office/outpatient visit est	$80.48
90791	Psych diagnostic evaluation	$127.76	99215	Office/outpatient visit est	$113.68
90792	Psych diag eval w/med srvcs	$142.91	99231	Subsequent hospital care	$40.06
90832	Psytx pt&/family 30 minutes	$63.88	99232	Subsequent hospital care	$73.62
90833	Psytx pt&/fam w/e&m 30 min	$66.40	99233	Subsequent hospital care	$106.10
90834	Psytx pt&/family 45 minutes	$85.17	99307	Nursing fac care subseq	$44.75
90836	Psytx pt&/fam w/e&m 45 min	$84.09	99308	Nursing fac care subseq	$70.37
90837	Psytx pt&/family 60 minutes	$127.40	99309	Nursing fac care subseq	$92.75
90838	Psytx pt&/fam w/e&m 60 min	$110.43	99310	Nursing fac care subseq	$136.78
90839	Psytx crisis initial 60 min	$133.17	99354	Prolonged service office	$124.15
90840	Psytx crisis ea addl 30 min	$63.88	99355	Prolonged service office	$93.47
90845	Psychoanalysis	$91.31	99356	Prolonged service inpatient	$94.19
90846	Family psytx w/o patient	$102.86	99357	Prolonged service inpatient	$94.92
90847	Family psytx w/patient	$106.83	99406	Behav chng smoking 3-10 min	$12.63
90951	Esrd serv 4 visits p mo <2yr	$959.98	99406	Smoking cessation 3-10 min	$12.63
90952	Esrd serv 2-3 vsts p mo <2yr	$0.00	99407	Behav chng smoking > 10 min	$26.71
90954	Esrd serv 4 vsts p mo 2-11	$832.59	99407	Smoking cessation >10 min	$26.71
90955	Esrd srv 2-3 vsts p mo 2-11	$469.16	99495	Trans care mgmt 14 day disch	$125.59
90957	Esrd srv 4 vsts p mo 12-19	$660.44	99496	Trans care mgmt 7 day disch	$165.65
90958	Esrd srv 2-3 vsts p mo 12-19	$448.59	99497	Advncd care plan 30 min	$80.48
90960	Esrd srv 4 visits p mo 20+	$291.24	99498	Advncd are plan addl 30 min	$75.79
90961	Esrd srv 2-3 vsts p mo 20+	$244.69	G0108	Diab manage trn per indiv	$57.02
90963	Esrd home pt serv p mo <2yrs	$557.95	G0109	Diab manage trn ind/group	$15.88
90964	Esrd home pt serv p mo 2-11	$487.93	G0270	Mnt subs tx for change dx	$29.23
90965	Esrd home pt serv p mo 12-19	$466.28	G0296	Visit to determ ldct elig	$27.79
90966	Esrd home pt serv p mo 20+	$244.33	G0396	Alcohol/subs interv 15-30mn	$33.92
90967	Esrd home pt serv p day <2	$18.41	G0397	Alcohol/subs interv >30 min	$66.04
90968	Esrd home pt serv p day 2-11	$16.24	G0406	Inpt/tele follow up 15	$39.70
90969	Esrd home pt serv p day 12-19	$15.52	G0407	Inpt/tele follow up 25	$73.26
90970	Esrd home pt serv p day 20+	$8.30	G0408	Inpt/tele follow up 35	$105.38
96116	Neurobehavioral status exam	$86.62	G0420	Ed svc ckd ind per session	$114.40

 

Medicare fee schedule for covered Telemedicine services

Code	Short Descriptor	National Fee	Code	Short Descriptor	National Fee
96156	Health behavior assessment	$90.58	G0421	Ed svc ckd grp per session	$26.71
96158	Health behavior intervention	$61.71	G0425	Inpt/ed teleconsult30	$101.77
96159	Health behavior intervention, additional 15	$21.29	G0426	Inpt/ed teleconsult50	$138.22
96160	Pt-focused hlth risk assmt	$2.53	G0427	Inpt/ed teleconsult70	$204.99
96161	Caregiver health risk assmt	$2.53	G0438	Ppps, initial visit	$172.87
96164	Health behavior intervention, group	$9.02	G0439	Ppps, subseq visit	$117.29
96165	Health behavior intervention, group	$3.97	G0442	Annual alcohol screen 15 min	$9.74
96167	Health behavior intervention, family	$66.04	G0443	Brief alcohol misuse counsel	$24.18
96168	Health behavior intervention, family	$23.46	G0444	Depression screen annual	$9.74
97802	Medical nutrition indiv in	$34.65	G0445	High inten beh couns std 30m	$24.18
97803	Med nutrition indiv subseq	$29.23	G0446	Intens behave ther cardio dx	$24.18
97804	Medical nutrition group	$16.24	G0447	Behavior counsel obesity 15m	$24.18
99201	Office/outpatient visit new	$27.07	G0459	Telehealth inpt pharm mgmt	$42.59
99202	Office/outpatient visit new	$51.61	G0506	Comp asses care plan ccm svc	$46.56
99203	Office/outpatient visit new	$77.23	G0508	Crit care telehea consult 60	$214.37
99204	Office/outpatient visit new	$132.09	G0509	Crit care telehea consult 50	$197.77
99205	Office/outpatient visit new	$172.51	G0513	Prolong prev svcs, first 30m	$62.80
99211	Office/outpatient visit est	$9.38	G0514	Prolong prev svcs, addl 30m	$62.80
99212	Office/outpatient visit est	$26.35	G2086	Off base opioid tx first m	$301.35
99213	Office/outpatient visit est	$52.33	G2087	Off base opioid tx, sub m	$293.77
			G2088	Off opioid tx month add 30	$35.01

 

Medicare fee schedule for covered Telemedicine services

Code	Short Descriptor	National Fee	Code	Short Descriptor	National Fee
99421	Online E &M service, 5-10 mint	$13.35	G2061	Nonphysician online assessment 5-10 mint	$12.27
99422	Online E &M service, 11-20 mint	$27.43	G2062	Nonphysician online assessment 11-20 mint	$21.65
99423	Online E &M service, >21 mint	$43.67	G2063	Nonphysician online assessment > 20 mint	$33.56

Medicare fee schedule for covered Virtual Check-ins

Code	Short Descriptor	National Fee	Code	Short Descriptor	National Fee
G2012	Virtual check-in 5-10 minutes	$13.35	G2013	Remote evaluation of recorded video/image	$9.38

Note: As part of the current waiver, payers can cover even more codes that are not listed here. If the service you are opting to deliver by telehealth are not listed above, please contact the respective insurance for verification.

Yes, almost all insurances cover telemedicine services. However, coverage can vary  depending on the patient’s plan.

No, following the HHS 1135 waiver, commercial insurances have also removed the restriction of originating and distant sites.

99201-99215 – Office E & M 99231-99233 – Hospital Follow-Ups (1 every 3 days) 99307-99310 – SNF visits (limited to 1 every 30 days) 99495-99498 – Transitional care management 99354-99357 – Prolonged care

99406-99407 – smoking cessation 96156-96168 – Health Risk Assessments 97802 -97804 – Medical Nutrition 90832 – 90838 – Psytx pt&/fam 90791- 90792 -Psych evaluation 90845 – 90846 – Family psytx 90951 – 90970 – Esrd home pt serv

 

Note: As part of the current waiver, payers can cover even more codes that are not listed here. If the services you are opting to deliver by telehealth are not listed above, please contact the respective insurance for verification.

The payment would vary from insurance to insurance and from patient to patient. Providers can contact individual commercial insurances to find out the contracted amount.

Yes, referral or authorization is required just like face-to-face services. However, after the national emergency declared by the US gov’t., many insurances have relaxed their requirements for referrals or authorization requirements.

Yes, the use of telehealth does not change the out of pocket costs for beneficiaries. Beneficiaries are generally liable for copay, deductible and coinsurance; however, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by insurances.

Commercial insurances that cover telemedicine

Insurance	Cover Telemedicine?	Billable Codes	Modifier(s)	POS
Aetna	Yes	Medicare Approved	—	2
Anthem	Yes	Medicare Approved	GT / 95	2
BCBS FL	Yes	Medicare Approved	GT / 95	2
BCBS ID	Yes	Medicare Approved	GT / 95	2
BCBS NC	Yes	Medicare Approved	GT / 95	2
BCBS NV	Yes	Medicare Approved	GT / 95	2
BCBS NY	Yes	Medicare Approved	GT / 95	2
Carefirst BCBS	Yes	Medicare Approved	GT / 95	2
Cigna	Yes	Medicare Approved	—	2
Emblem Health	Yes	Medicare Approved	GT / 95	2
Fidelis	Yes	Medicare Approved	GT / 95	2
GHI	Yes	Medicare Approved	GT / 95	2
Health Care Partners	Yes	Medicare Approved	GT / 95	2
Health First	Yes	Medicare Approved	GT / 95	2
HEALTH PLAN OF NV	Yes	Medicare Approved	—	2
HEALTHSCOPE	Yes	Medicare Approved	—	2
HIP	Yes	Medicare Approved	GT / 95	2
MERITAIN HEALTH	Yes	Medicare Approved	—	2
Oxford Health Plan	Yes	Medicare Approved	GT / 95	2
Regence	Yes	Medicare Approved	—	2
Select Health	Yes	Medicare Approved	GT / 95	2
Senior Care Plus	Yes	Medicare Approved	—	2
SIERRA HEALTH AND LIFE	Yes	Medicare Approved	—	2
STARMARK	Yes	Medicare Approved	—	2
TRICARE	Yes	Medicare Approved	GT / 95	2
TRICARE WEST	Yes	Medicare Approved	GT / 95	2
TRIWEST-VAPC3	Yes	Medicare Approved	GT / 95	2
UMR	Yes	Medicare Approved	GT / 95	2
UNITED HEALTH CARE	Yes	Medicare Approved	GT / 95	2
Value Options	Yes	Medicare Approved	GT / 95	2
Wellcare	Yes	Medicare Approved	GT / 95	2

Note: Forty (40) states and the District of Columbia govern private payer telehealth reimbursement policies. This is not a complete list of insurances, but major insurances are included. Practices should call individual insurance payers before delivering services to make sure that their telemedicine services are covered under patient benefits.

The originating site is the location of the patient at the time the service is being furnished. The distant site is the site where the physician or other licensed practitioner delivering the service is located.

• Forty-nine (49) state boards, plus the medical boards of District of Columbia, Puerto Rico, and the Virgin Islands, require that physicians engaging in telemedicine are licensed in the state in which the patient is located.
• Twelve (12) state boards issue a special purpose license, telemedicine license or certificate, or license to practice medicine across state lines to allow for the practice of telemedicine.
• Six (6) state boards require physicians to register if they wish to practice across state lines.

• All states and the District of Columbia provide reimbursement for some form of live video in Medicaid fee-for-service at the same rate they pay face to face visits.
• Fourteen (14) states reimburse for store-and-forward.
• Twenty-two (22) states reimburse for remote patient monitoring.

• Eight (8) states reimburse for all three, with certain limitations.

99201-99215 – Office E & M 99231-99233 – Hospital Follow-Ups (1 every 3 days) 99307-99310 – SNF visits (limited to 1 every 30 days) 99495-99498 – Transitional care management 99354-99357 – Prolonged care

99406-99407 – smoking cessation 96156-96168 – Health Risk Assessments 97802 -97804 – Medical Nutrition 90832 – 90838 – Psytx pt&/fam 90791- 90792 -Psych evaluation 90845 – 90846 – Family psytx 90951 – 90970 – Esrd home pt serv

Note: As part of the current waiver, payers can cover even more codes that are not listed here. If the services that you intend to deliver via telehealth are not listed above, please contact the respective insurance for verification.

Almost all states require the Place of Service code 02- telemedicine along with the GT modifier on the HCFA 1500 claim form.

The covered services vary from state to state. Please review the charts given below to find out which state Medicaid covers what services.

For Medicare claims, you can bill claims with just POS 02. But for commercial insurances, you have to check with insurance what are their guidelines on billing telemedicine claims. Do they need GT/95 modifier or submitting claim under POS 02 would be enough.

Please go through below link to check your state guidelines:

https://www.cchpca.org/telehealth-policy/current-state-laws-and-reimbursement-policies#