There is three options Medical Coding Update for Telehealth and other communications-based technology services i.e. Telephone calls, Internet consultations, and Telemedicine exams. This information is based on guidelines from the Centers for Medicare & Medicaid Services.
2020 Medical Coding Update for Telehealth
1. Telephone Calls
HCPCS code G2012 Description: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional 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.
- 2020 wRVU: 0.25
- National non-facility payment: $14.80
- National facility payment: $13.35
Code |
Value |
Description |
HCPCS code G2012 | $14.81 Medicare Part B | 5-10 minutes of medical discussion |
Coverage varies per commercial plan |
Documentation Requirements for HCPCS code G2012
- Confirm patient identity (e.g., name, date of birth, or other identifying information as needed, in particular, if documenting independently from the patient’s electronic or paper record).
- Confirm that the patient is an established patient to the practice.
- Detail what occurred during the communication (e.g., patient problem(s), details of the encounter as warranted) to establish medical necessity.
- Document the total amount of time spent in communicating with the patient and only submit code G2012 if a minimum of five minutes of direct communication with the patient was achieved.
- The document that the nature of the call was not tied to a face-to-face office visit or procedure that occurred within the past seven days.
- The document that a subsequent office visit for the patient’s problems was not indicated within 24 hours or the next available appointment.
- Include that the patient provided consent for the service.
Service Provider Telehealth: MDs, DOs, ODs
HCPCS code 99441 Description: Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian 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. Non-covered Medicare services, coverage varies per commercial plan.
Code |
Description |
99441 | 5-10 minutes of medical discussion |
99442 | 11-20 minutes of medical discussion |
99443 | 21-30 minutes of medical discussion |
Service Provider: Physician Assistants or Nurse Practitioners
HCPCS code 98966 Description: Telephone assessment and management service provided by a qualified non-physician, health care professional to an established patient, parent, or management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment. Non-covered Medicare services, coverage varies per commercial plan.
Code |
Description |
98966 | 5-10 minutes of medical discussion |
98967 | 11-20 minutes of medical discussion |
98968 | 21-30 minutes of medical discussion |
- Initiated by established patients
- If the telephone service ends with a decision to see the patient within 24 hours or the next available urgent visit appointment, the code is not reported. The encounter is considered part of the preservice work of the subsequent assessment and management service, procedure, and visit.
- If the call refers to a service performed and reported within the previous seven days or within the post-operative period of the previously completed procedure, then the service is considered part of the previous service or procedure.
2. Internet Consultations
- Initiated by established patients
- Covers seven days
- Not to be used for:
- Scheduling appointments
- Conveying test results
- Must be through HIPAA compliant secure platforms such as:
- Electronic health record portals
- Secure email, etc.
Service Provider: Physicians
HCPCS code 99421 Description: Online digital E/M service, for an established patient, for up to seven days, the cumulative time during the seven days.
Code |
Value |
Description |
99421 | $ 15.52 | 5-10 min |
99422 | $ 31.04 | 11-20 minutes |
99423 | $ 50.16 | 21 or more minutes |
Service Provider: (Non-Physicians) Physician Assistants and Nurse Practitioners
HCPCS code 98970 Description: Online digital E/M service, for an established patient, for up to seven days, the cumulative time during the seven days. Non-covered Medicare services, coverage varies per commercial plan.
Code |
Description |
98970 | 5-10 min |
98971 | 11-20 minutes |
98972 | 21 or more minutes |
3. Telemedicine Exams
Telemedicine is defined by a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician.
- The examination and communication of information exchange between the physician and the patient must be the same as when rendered face-to-face.
- Code-level selection is based on the same criteria for the base codes.
- Telemedicine codes are identified by an asterisk (*) in the CPT book
- Office-based
- 99201 – 99205 E/M new patient
- 99212 – 99215 E/M established patient
- Does not apply to tech code 99211 or Eye visit codes
Office consultations
- For insurance that still recognizes this family of codes: 99241 – 99245
- Subsequent Hospital Care: 99231 – 99233
- Inpatient Consultation: 99251 – 99255
- Subsequent Nursing Facility Care: 99307-99310
- Append modifier -95 Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications systems.
- List the place of service as 2.
In case of any assistance needed for telehealth medical billing and coding, you can contact Medical Billers and Coders (MBC) at 888-357-3226/ info@medicalbillersandcoders.com
Reference:
Coding for Phone Calls, Internet and Telehealth Consultations