What Are CPT Codes for Telehealth?

Standard E&M office visit codes (such as 99213, 99214) will normally be billed, along with a telehealth location of service and maybe a modifier. This is why Medicare is said to be as Medicare telehealth services whenever needed by someone paying commercially.

The communications-based technology by Medicare, codes are divided into two categories: Virtual Check In and E-Visits. CMS has determined that neither of these visits is Medicare “telehealth services,” which means they are not subject to the usual statutory constraints on originating location or rural geography, however, CMS has waived these requirements during current public emergency. Regardless of whether a national emergency has been declared, these services can be provided at the patients’ homes.

A virtual check-in means a small communication in between the patient and the practitioner via cellphone or any other telecommunication device. This is for the evaluation to know if it is important to visit the office. Due to the public health emergency, virtual check-ins do require an established patient relationship with the physician the patient is meeting within the last three years, which CMS has not waived. A virtual check-in cannot be linked to a previous medical visit within the last seven days, and it does not result in a medical visit within the next 24 hours. The following are the two virtual check-in codes:

  • G2012: A quick communication technology-based service provided to an established patient by a physician or other competent healthcare provider who can report assessment and management services that does not get arise from any linked service by E/M given in the previous week and does not even further lead to any of the E/M process or service in the next 24 hours or any soon consultation that will just last for 5 to 10 minutes for medical discussion.
  • G2010: Virtual assessment of image or video recording that is sent by any of the reputable patient alongside the interpretation and following the patient in between the 24 working hours that gets don arise from a relation with E/M service given in between the past seven days neither lead to more E/M services for the further 24 hours nor to any appointment available very soon.
  • 99441: The evaluation and management services via telephone by any doctor or someone else qualified enough as a healthcare professional liable to report management and evaluation services given to the reputable patient, guardian or parent not arising from relevant E/M provided services in the past seven days and not even going ahead to an E/M service or procedure in the next upcoming 24 hours or any soon appointment that could be only 5 to 10 minutes of medical discussion.
  • 98966: Assessment and management services using telephone provided by any qualified healthcare profession that is non-physician to the reputable parent, guardian or patient that is not arise from any related evaluation and management services provided in the past week and does not even lead to an evaluation and management service or process in the next working day or any time soon.
  • G0071: Payment for the services based on communication technology for 5 minutes or more specifically for an online communication in between the Rural Health Clinic RHC or FQHC i.e. Federally Qualified Health center practitioner and the patient of RHC or FQHC. Or 5 minutes or more than that of remote evaluation of images or recorded video by the practitioner of RHC or FQHC that occurs in lieu of the office visit only in RHC or FQHC.

Do Patients Owe a Copay or Telehealth Services?

Most of the plans say that they are waiving copays until and unless the next notice arrives.

  • Medicare: For each CMS, the anti kickback rule for any of the services that is paid by Medicaid, Medicare, or CHIP does not get enforced following the telehealth visits. This supposed to mean that the providers are allowed to waive or decrease the cost sharing for telehealth visits without any penalty but they are not needed to waive the fees.
  • Aetna: Aetna offers zero co-pay for telemedicine visits for any particular reason.
  • Humana: Over the next 90 days the current waiving member cost share for the urgent care telehealth visits. It is because you do not need to collect payment from Medicaid, Humana Medicare Advantage and Commercial HAS patient for these services. Humana will give more information for determining if any of the other ASO group sponsored plans get chose out of the cost share waivers.

All in all, this is some brief information about telehealth billing services and CPT coding. Hopefully, it will help you.