Keeping accurate records of telehealth reimbursements has a direct impact on the bottom line of your healthcare organization. To assist you in navigating telehealth billing for your care program, we've gathered a list of telehealth CPT codes.
Telehealth, telemedicine, and other related terms refer to the exchange of medical information from one location to another via electronic communication in order to improve a patient's health. Innovative applications of this type of technology in healthcare are becoming more common. With the emergence of the virus that causes COVID-19, there is an urgent need to expand the use of technology to assist people who require routine care and to keep vulnerable beneficiaries and beneficiaries with mild symptoms in their homes while maintaining access to the care they require.
Types of virtual services
There are three main types of virtual services physicians and other professionals can provide to Medicare beneficiaries summarized in this fact sheet:
- Medicare telehealth visit
- virtual check-ins
When discussing coding and billing for services rendered via telehealth, it is important to note that telehealth is how the service is provided to the patient. In order for a provider to submit a claim for the service, the payer must cover the service in question as well as allow the service to be administered via telehealth.
Due to the spread of COVID-19, both public and private health insurers have taken steps to increase access to telehealth services. These visits are treated the same as in-person visits and are billed and reimbursed by CMS at the same rate.
Telehealth Coding Billing CPT codes for Video, Virtual, and e-visit
Below you will find a summary of the major telehealth policy changes, as well as information on how to code and bill for the remote management of patients.
Synchronous audio/visual evaluation and management visit:
99201-99205: Office/outpatient E/M visit, new
99210-99215: Office/outpatient E/M visit, established
G0425-G0427: Consultations, emergency department or initial inpatient (Medicare only)
G0406-G0408: Follow-up inpatient telehealth consultations for patients in hospitals or SNFs (Medicare only)
Online digital E/M services for the established patients for a period of up to 7 days, a cumulative time during the 7 days. These codes can be billed once a week and cannot be billed within a 7-day period of a separately reported E/M service unless the patient is initiating an online inquiry for a new problem not addressed in the separately reported E/M visit.
Medicare Part B also pays for E-visits or patient-initiated online evaluation and management conducted via a patient portal. Practitioners who may independently bill Medicare for evaluation and management visits (for instance, physicians and nurse practitioners) can bill the following codes:
99421: Online digital evaluation and management service, for an established patient, for up to 7 days, a cumulative time during the 7 days; 5–10 minutes
99422: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes
99423: Online digital evaluation and management service, for an established patient, for up to 7 days, a cumulative time during the 7 days; 21 or more minutes.
Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech-language pathologists, and clinical psychologists) can also provide these e-visits and bill the following codes:
G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, a cumulative time during the 7 days; 5–10 minutes
G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, a cumulative time during the 7 days; 11–20 minutes
G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, a cumulative time during the 7 days; 21 or more minutes.
Virtual check-ins are brief communications between doctors and patients, such as text messaging. Providers can deliver virtual check-ins using a
range of communications since they don't require both audio and video capability. CMS expects that patients will initiate most virtual check-ins
by, for example, emailing their primary-care doctor.
Medicare pays for these “virtual check-ins” for patients to communicate with their doctors and avoid unnecessary trips to the doctor’s office. These virtual check-ins are for patients with an established relationship with a physician or certain practitioners. 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.
G2012: Brief communication (5-10 minutes) technology-based service, new or established
G2010: Remote evaluation of recorded video and/or images submitted, new or established, including interpretation and follow-up within 24 business hours.
Telehealth services such as evaluation and management visits, mental health counseling, and preventive health screenings will allow Medicare beneficiaries who are at a higher risk for COVID-19 to see their doctor without having to travel to a doctor's office or hospital, putting themselves and others at risk.