Telephone or Telehealth CPT codes.
E/M cpt codes – 99201-99205 & 99212- 99215 Will be consider for Televisit codes.
What is a Telehealth Visit?
A visit with a provider that uses telecommunication systems between a provider and a patient. Telemedicine visits are considered the same as in-person visits, and per CMS, require real-time communication between providers and patients using both audio and video. CMS IS WAIVING THE REQUIREMENT FOR BOTH AUDIO AND VIDEO CONNECTIVITY DURING THE COVID-19 PUBLIC HEALTH EMERGENCY
Audio & Video Telehealth Visits
FQHC’s and RHC-must use audio and video to be considered a telehealth visit!
• Medicare’s Telehealth Service Spreadsheet lists which visits can be done via telehealth, including which cpt codes can be audio only
• Each commercial payer determines which services are covered via telehealth and whether or not audio only qualifies.
• E/M cpt codes 99201-99205 & 99212- 99215
• Claim Requirements:
• Most commercial payers require a 95 modifier, including Medicare (except FQHC’s and RHC’s)
• Most Medicaid plans require a GT modifier
• United Healthcare Medicare solutions requires a GT modifier for UB claims
Place of service is the POS that you would have normally billed for an in person visit
Billing Guidelines
**Due to the COVID-19 public health emergency (PHE), variations of the telemedicine rules will be implemented. We will update this document as much as we can; however, for current updates, please refer to the COVID-19 coding resource on www.aap.org/coding ** For the purpose of this resource, telemedicine will be defined as: “a two-way, real- time interactive communication between a patient and a physician or practitioner at a distant site through telecommunications equipment that includes, at a minimum, audio and visual equipment.” The reporting of telemedicine services varies by payer and state regulations. In 2017, Current Procedural Terminology (CPT) published a new modifier and a new appendix related to telemedicine services. While the Centers for Medicare and Medicaid Services (CMS) have recognized telemedicine services for quite some time, the launch of the CPT infrastructure facilitates recognition by private and public payers.
Telemedicine services may make up 2 distinct services, depending on where the patient is located during the telemedicine encounter. Table 1 outlines the different coding and billing requirements whether you are the “performing physician/provider” or the “hosting facility.” In addition, since alternate terms may be used, we have included those, as well:
CPT manual) for a real time interaction between a physician or other qualified healthcare professional and a patient who is located at a distant site from the reporting provider. The totality of the communication of information exchanged between the reporting provider and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. Codes must be listed in Appendix P or have the symbol.
GT modifier: Via interactive audio and video telecommunication systems. Use only when directed by your payer in lieu of modifier 95
GQ modifier: Providers participating in the federal telemedicine demonstration programs in Alaska or Hawaii must submit the appropriate CPT or HCPCS code for the professional service along with the modifier GQ, “via asynchronous telecommunications system.”
02 Telehealth*: The location where health services and health related services are provided or received, through a telecommunication system. (Effective January 1, 2017) *CMS refers to POS 02 as ‘telehealth’ even though it is more accurately described as ‘telemedicine’ per the definition on page one of this document
BCBS insurance Guidelines.
The purpose of the Telemedicine Medical Services and Telehealth Services policy is to provide guidance on payment and coding for services that are provided to a patient by a network healthcare provider, not at the same physical location. These services can be performed through various interactive telecommunication or information technology devices.
Tele Medical service – A health care service delivered by a physician licensed in Texas, or a health professional acting under the delegation and supervision of a physician licensed in Texas and acting within the scope of the physician’s or health professional’s license to a patient at a different physical location than the physician or health professional using telecommunications or information technology.
Telehealth service – A health service, other than a telemedicine medical service, delivered by a health professional licensed, certified, or otherwise entitled to practice in Texas and acting within the scope of the health professional’s license, certification, or entitlement to a patient at a different physical location than the health professional using telecommunications or information technology. All telehealth services must be provided in compliance with the standards that are established by the licensing or certifying board of the health professional providing the services.
1. The coding scenarios in this document are designed to apply best coding practices. The American Medical Association (AMA) has worked to ensure that all payors are applying the greatest flexibility to our physicians in providing care to their patients during this public health crisis.
2. The Centers for Medicare & Medicaid Services (CMS) lifted Medicare restrictions on the use of telehealth services during the COVID-19 emergency. Key changes effective March 1, and lasting throughout the national public health emergency include:
• Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19
• Patients can receive telehealth services in all areas of the country and in all settings, including at their home.
• CMS expanded the list of services eligible to be reported via telehealth (link here)
• CMS will permit reporting of telehealth E/M office or other outpatient visits based on time or Medical Decision Making (MDM).
• The Qualified Healthcare Professionals that are eligible for telehealth has been expanded. Additional codes for these services were also added to the CMS telehealth list.
• CMS has clarified that telehealth services are permitted with both new and established patients.
• Physicians can reduce or waive cost-sharing for telehealth visits. In addition, all cost-sharing for Medicare beneficiaries is waived for COVID19 testing and visits related to the testing. Modifier CS – Cost sharing must be appended to these claims to ensure cost-sharing.
• Physicians licensed in one state can provide services to Medicare beneficiaries in another state. State licensure laws still apply.
3. HHS Office for Civil Rights offers flexibility for telehealth via popular video chat applications, such as FaceTime or Skype, during the pandemic.
UHC Reimbursement
UnitedHealthcare will consider for reimbursement the following Telehealth services when they are rendered via audio and video and reported with place of service POS 02 (the location where health services and health related services are provided or received, through a telecommunication system):
•Services recognized by the Centers for Medicare and Medicaid Services (CMS), and
•Services recognized by the American Medical Association (AMA)included in Appendix P of the CPT code set, and
•Additional services identified by UnitedHealthcare that can be effectively performed via Telehealth. See the Telehealth Eligible Services Code List in the Attachments section.
The Originating Site is where the member is housed with a Telepresenter during a Telehealth encounter. UnitedHealthcare recognizes the CMS-designated Originating Sites considered eligible for furnishing Telehealth services to a patient located in an Originating Site. The Originating Site may submit a claim for the services of the Telepresenter with code Q3014.Examples of CMS Originating Sites:
•The office of a physician or practitioner
•A hospital (inpatient or outpatient)
•A critical access hospital (CAH)
•A rural health clinic (RHC)
•A federally qualified health center (FQHC)
•A hospital-based or critical access hospital-based renal dialysis center (including satellites); NOTE: Independent renal dialysis facilities are not eligible Originating Sites
•A skilled nursing facility (SNF)
As described byCMS,thetypes of care providers eligible to deliver Telehealth servicesinclude, for example:
•Physician
•Nurse practitioner
•Physician assistant
•Nurse-midwife
•Clinical nurse specialist
•Registered dietitian or nutrition professional
Telehealth/Telemedicine Telehealth services are live, interactive audio and visual transmissions of a physician-patient encounter from one site to another using telecommunications technology. They may include transmissions of real-time telecommunications or those transmitted by store-and-forward technology.
Telehealth Eligible Services Code List added, PT/OT/ST Telehealth Eligible Services Code List added, Communication Technology Based Services and Remote Physiologic Monitoring Eligible Code List added, Communication Technology-Based and Other Related Services Non-Eligible Code List added History prior to 1/1/2019 archived
CPT TELEMEDICINE CODES
Modifier 95 indicates a synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. The 2020 CPT® manual includes Appendix P, which lists a summary of CPT codes that may be used for reporting synchronous (real-time) telemedicine services when appended by modifier 95. Procedures on this list involve electronic communication using interactive telecommunications equipment that includes, at a minimum, audio and video.
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