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||-||-||-||-|