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Last Modified: 4/11/2024 Location: FL, PR, USVI Business: Part A, Part B

Telemedicine and remote services

Medicare covers the following telemedicine services:
Telehealth visits
Telephone services
Virtual check-ins
E-Visits
The corresponding guidelines are effective with dates of service on and after May 12, 2023.

Telehealth services

Telehealth services are defined as services a physician or practitioner provides via two-way, interactive technology (or telehealth). Telehealth substitutes for an in-person visit and generally involves two-way, interactive technology permitting communication between the practitioner and patient.
For most non-behavioral or mental telehealth, you must use two-way, interactive, audio-video technology. The Consolidated Appropriations Act (CAA) 2023 external pdf file allows you to use audio-only telehealth for certain non-behavioral or mental telehealth through December 31, 2024.
A listing of covered Medicare Telehealth Services external link is available on the CMS website.
Visit our article for additional information on telehealth services.

Telephone services

Telephone services are defined as virtual patient communication codes used to report telephone evaluation and management (E/M) for beneficiaries who need routine, uncomplicated follow-up for chronic disease or routine primary care.
Telephone services cannot be billed if they originate from a related E/M service provided within the previous seven days or lead to an E/M service or procedure within the next 24 hours or soonest available appointment.
These services are reported for non-face-to-face patient-initiated communications with their practitioner using a telephone.
With the end of the PHE, the CAA external pdf file provides for an extension for this flexibility through December 31, 2024.
Physician and non-physician practitioners can provide telephone services to established patients only.

Telephone services -- Coding and billing

Physicians, nurse practitioners and physician assistants report the following:

CPT Code
Description
99441
Telephone E/M service by a physician or other qualified health care professional (QHP) who may report E/M services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days or leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
99442
Telephone E/M service by a physician or other QHP who may report E/M services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days or leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.
99443
Telephone E/M service by a physician or other QHP who may report E/M services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days or leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion.
Non-physician clinicians (including physical therapists [PTs], occupational therapists [OTs, speech language pathologists [SLPs], licensed clinical psychologists [CPs]), clinical social workers [CSWs), registered dietitians and nutrition professionals) report the following:

CPT Code
Description
98966
Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days not leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
98967
Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days not leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.
98968
Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days not leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment: 21-30 minutes of medical discussion.
For telephone services, follow telehealth billing guidelines found in the code listing of Medicare Telehealth Services external link available on the CMS website.

Virtual check-ins

Virtual check-ins are defined as brief communication technology-based services (CTBS) check-ins with the patient’s practitioner via telephone or other telecommunications device to decide whether an office or other service is needed. A remote evaluation of recorded video or images may be submitted by the patient.
Virtual check-ins are typically initiated by the patient. Healthcare professionals may need to educate beneficiaries on the availability of the service prior to patient initiation.
Clinicians can provide virtual check-in services to established patients only.
Patient must verbally consent to receive virtual check-in services.

Coding and billing

Physicians, nurse practitioners and physician assistants report the following:

CPT Code
Description
G2010
Remote evaluation of recorded video or images submitted by an established patient (e.g., store and forward), including interpretation and follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
G2012
Brief communication technology-based service (CTBS), e.g., virtual check-in, by a physician or other QHP who can report E/M services, provided to an established patient, not originating from a related E/M service provided within the previous seven 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.
Non-physician clinicians (including PTs, OTs, SLPs, licensed CPs, CSWs, registered dietitians and nutrition professionals) report the following:

CPT Code
Description
G2251
Brief CTBS, e.g., virtual check-in, by a QHP who cannot report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to a service or procedure within the next 24 hours or soonest available: 5-10 minutes of clinical discussion.
G2252
Brief CTBS, e.g., virtual check-in, by a physician or other QHP who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.
Report the place of service (POS) external pdf file equal to what it would have been had the service been furnished in-person.

E-visits

CMS defines e-visits as communication between a patient and their provider through an online portal.
Clinicians can provide e-visits services to established patients only.
Physicians and other QHPs report the following:

CPT Code
Description
99421
Online digital E/M service, for an established patient, for up to seven days, cumulative time during the seven days; 5-10 minutes.
99422
Online digital E/M service, for an established patient, for up to seven days cumulative time during the seven days; 11-20 minutes.
99423
Online digital E/M service, for an established patient, for up to seven days cumulative time during the seven days; 21 or more minutes.
Non-physician clinicians (including PTs, OTs, SLPs, licensed CPs, CSWs, registered dietitians and nutrition professionals) report the following:

CPT Code
Description
98970
Qualified non-physician healthcare professional online digital assessment and management, for an established patient, for up to seven days, cumulative time during the seven days; 5-10 minutes.
98971
98972
Qualified non-physician qualified healthcare professional online digital assessment and management service, for an established patient, for up to seven days, cumulative time during the seven days; 21 or more minutes.
Report the POS external pdf file equal to what it would have been had the service been furnished in-person.

Remote mental health services

If the beneficiary is in a hospital and receives a hospital outpatient clinic visit (including a mental or behavioral health visit) from a practitioner in the same physical location, then the hospital would bill for the clinic visit using HCPCS code G0463.
If the beneficiary is in their home and receives a mental or behavioral health service from hospital staff using telecommunications technology and no separate professional service can be billed, then the hospital would bill for the Outpatient Prospective Payment System (OPPS) specific codes to describe that the patient must be in their home and no associated professional service is billed under the physician fee schedule (PFS). The applicable HCPCS C-codes describing this service would be HCPCS codes C7900-C7902.
Hospital staff performing these services must be licensed to provide these services consistent with all applicable state scope of practice laws. These services are exempt from having staff be physically located in the hospital or outpatient department when providing services remotely using communication technology.

CPT Code
Description
C7900
Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, initial 15-29 minutes, provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service.
C7901
Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, initial 30-60 minutes, provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service.
C7902
Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, each additional 15 minutes, provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service (list separately in addition to code for primary service).
Note: HCPCS codes C7900 and C7901 are assigned ambulatory payment classifications (APCs) based on the PFS facility payment rates for CPT codes 96158 and 96159. C7902 is an add-on code; payment is packaged, and the code is not assigned an APC.

References

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