Please ensure that you follow these guidelines when submitting claim
- Submit these claims with the place of service 02.
- For Medicare, modifier 95 is not required (will recommend for commercial payers)
- You can also opt for time based billing
Per Medicare rule for COVID
- The provider must use an interactive audio and video telecommunication system.
- HIPAA privacy rules waived: may use FaceTime, Skype, Messenger video chat, Google hang out video
- May not use applications that are front facing, such as facebook live, twitch or TikTok
- CMS instructs groups to notify the patient that third party platforms may have privacy risk
- Practitioners who may bill for telehealth include physicians, advanced practice registered nurses, physician assistants, CRNAs, clinical psychologists, clinical social workers, registered dietitians and nutrition professionals.
- Visits are paid at the same rate as in person visits.
- The provider may waive the co-pay/deductible but is not required to do so.
- RHCs and FQHCs should use modifier GT on claims.
- This relaxation of rules is in effect during the state of emergency, and isn’t a permanent change, under the law passed March 6.
- CMS is paying the service using the facility (lower) rate not the non-facility (office rate)
| Telemedicine Options + Key Indicators | CPT Code | Description | Fac Fee | Non-Fac Fee |
Virtual Checkin: Can be any real-time audio (telephone), or "2-way audio interactions that are enhanced with video or other kinds of data transmission." | G2010 | Remote evaluation of recorded video and/or images submitted by an established patient (e.g. store and forward), including interpretation with followup 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. | $ 9.38 | $ 12.27 |
| G2012 | Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report E&M 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. | $ 13.35 | $ 14.80 | |
Online Digital Evaluation and Management (E/M): must be patient initiated; Can be done synchronously and asynchronously and audio/video phone can be used (but not a traditional telephone). | 99421 | Patient-initiated digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes | $ 13.35 | $ 15.52 |
| 99422 | ….11-20 minutes | $ 27.43 | $ 31.04 | |
| 99423 | ….21 or more minutes | $ 43.67 | $ 50.16 | |
Remote Monitoring: established patients only; follow-up can be by phone, audio/video, secure text messaging, email or patient portal communication; involves "asynchronous transmission of healthcare information" from the patient | 99453 | Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment | $ 18.77 | $ 18.77 |
| 99454 | Remote monitoring of physiologic parameter(s) (eg, weight, BP, pulse oximetry, respiratory flow rate) initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days | $ 62.44 | $ 62.44 | |
| 99457 | Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff, physician, or other qualified health professional time in a calendar month requiring interactive communication with the patient/caregiver during the month | $ 32.84 | $ 51.61 | |
Telephone call: Telephone only (no video) are reimbursable for new or established patients | 99441 | Telephone E/M service provided by a physician 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 hrs or soonest available appointment, 5-10 medical discussion | $ 13.45 | $ 14.44 |
| 99442 | …11-20 minutes | $ 26.71 | $ 28.15 | |
| 99443 | …21-30 minutes | $ 39.70 | $ 41.14 | |
| Allowed telehealth services: direct link to CMS | - | - | - | - |
Resources:
https://www.ama-assn.org/practice-management/digital/ama-quick-guide-telemedicine-practice
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
https://www.aap.org/en-us/Documents/coding_factsheet_telemedicine.pdf