CMS expanded telemedicine benefits with the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.  This expansion will allow payment for office, hospital and other visits furnished via telehealth.

 

The start date for this benefit is March 6, 2020 and it will go through the COVID-19 emergency.

 

Medicare beneficiaries can receive services including:

 

  • Evaluation and management (E&M)
  • Mental health counseling
  • Preventive health screenings

 

CMS identifies three main types of virtual services which include:

 

  • Virtual Check-ins
  • E-visits
  • Medicare Telehealth Visits

 

The following are coding tips related to this benefit pulled together by TrustHCS coding leadership.

 

Virtual Check-in – Established Patients ONLY

 

  • Utilizes telephone or other telecommunication, for a brief check in, to decide if an office visit or other service is needed. Remote evaluation of recorded video and/or images submitted by an established patient.
  • Patients must verbally consent to receive virtual check-in services
  • Medicare coinsurance and deductible would generally apply to these services

 

Code Description
G2010 Remote Eval Recorded Video And/or Images Submitted by Established Patient (e.g., Store and Forward)
G2012 Brief Communication Technology-Based Service, Virtual Check-In, By A Physician or Other QHCP

 

E-Visits – Established Patients ONLY

 

  • Utilizes communication between provider and patient through an online patient portal
  • Patient must generate the initial inquiry and communication can occur over a 7-day period
  • Medicare coinsurance and deductible would generally apply to these services

 

99421 – 99423 – Physician and nurse practitioners can provide e-visits and bill utilizing the following codes:

Code Description
99421 Online Digital E&M Service Established Patient, Up To 7 Days, Cumulative Time During the 7 Days 5-10 Minutes
99422 Online Digital E&M Service Established patient, Up To 7 Days, Cumulative Time During the 7 Days; 11-20 Minutes
99423 Online Digital E&M Service Established Patient, Up To 7 Days, Cumulative Time During the 7 Days; 21 or More Minute

 

 

G2061 – G2063 – Physical therapists, occupational therapists, speech language pathologists, clinical psychologists can provide e-visits and bill utilizing the following codes:

Code Description
G2061 Qualified Nonphysician Healthcare Professional Online Assessment, Established Patient, Up To 7 Days, 5-10 Min
G2062 Qualified Nonphysician Healthcare Professional Online Assessment, Established Patient, Up To 7 Days, 11-20 Min
G2063 Qualified Nonphysician Healthcare Professional Assessment, Established Patient, Up To 7 Days, 21 Or More Minutes

 

Medicare Telehealth Visits

 

  • Utilizes telecommunication between provider and patient
  • These visits are considered the same as in-person visits and will be paid at the same rate as regular, in-person visits
  • The OIG is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs
  • During the state of emergence can be assigned to new or established patient
    • NOTE: To the extent of waiver 1135 requires the patient be established, HHS will not conduct audits to determine if a prior relationship existed during this public health emergency.

 

Code Description
99201 -99215 Office and Other Outpatient Visits
G0406 Follow-Up IP Consultation, Limited, Physicians Spend 15 Minutes Communicating w Pt Via Telehealth
G0407 Follow-Up IP Consult, Intermediate, Physicians Spend 25 Minutes Communicating w Pt Via Telehealth
G0408 Follow-Up IP Consultation, Complex, Physicians Spend 35 Minutes Communicating w Pt Via Telehealth
G0425 Telehealth Consult, Emergency Depart or Initial IP, 30 Minutes Communicating w Pt Via Telehealth
G0426 Telehealth Consult, Emergency Depart or Initial IP, 50 Minutes Communicating w Pt Via Telehealth
G0427 Telehealth Consult, Emergency Depart Or Initial IP, 70+ Minutes Communicating w Pt Via Telehealth

 

Reference:  https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

 

QUESTIONS? SUPPORT?

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