The Centers for Medicare and Medicaid Services (CMS) and private payers have updated their regulations during the pandemic. CMS changes will remain in effect until the end of the public health emergency (PHE), which is expected to last through the end of 2021. Private payer policies vary and you need to check with them on a regular basis to make sure you are in compliance.
During the COVID-19 national emergency, certain provisions of HIPAA will not be enforced for covered health care providers utilizing telehealth services. This allows clinicians some flexibility to utilize technologies that may not be fully compliant with HIPAA rules. For example, a clinician may use the private video chat functions in common apps, such as Facebook Messenger, Zoom, or Google Hangouts. However, public-facing apps (e.g., Facebook Live, TikTok) are not allowed. Read the full notification of enforcement discretion here.
Commercial insurance rules regarding telemedicine vary by state. Check with the individual payer or your state medical society for the most up to date guidance. You can also encourage your patients to check with their insurance provider for information on coverage of telemedicine visits.
Here are some general guidelines from AAAAI coding consultant Teresa Thompson:
- Use standard E/M visit codes for established patients (99211-99215) or new patients (99201-99205) with place of service as 02 or 11 depending on the payer and modifier 95 (or in some cases, GT) to indicate a telehealth visit. Check with the payer to confirm which codes/modifiers they require.
- Your documentation must support the level of service.
- Use time if more than 50% of the visit is in counseling and coordination of care. Key components for documentation using time include:
- Total time spent with the patient
- Percentage covering counseling/coordination of care
- Encounter details
Evisits are online digital evaluation and management services for an established patient for up to seven days. Code for cumulative time over the seven days.
- 99421 – Five-10 minutes
- 99422 – 11-21 minutes
- 99423 – 21 or more minutes
For Medicare patients, there are additional codes for professional assessment and management services by qualified non-physician providers:
- G2061 – Five-10 minutes
- G2062 – 11-20 minutes
- G2063 – 21 or more minutes
You can bill for telephone encounters provided the visit is with an established patient, parent or guardian 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. Refer to payer websites to confirm insurance coverage; if this is not a covered service, the provider should notify the patient, who then may be responsible for payment. Some insurers may require or waive patient co-payments. Review payer policies to verify coverage benefits.
Use codes 99441-99443 for telephone evaluation and management service by a physician or other qualified healthcare professional.
- 99441 – Five-10 minutes of medical discussion
- 99442 – 11-20 minutes of medical discussion
- 99443 – 21 minutes or more of medical discussion
For Medicare patients, CMS is allowing the use of codes 99441-99443 for telephone visits as described above for both established and new patients. You can also use G2012 for a brief (five-10 minutes) check in via telephone or other telecommunications device to decide whether an office visit or other service is needed.
How to Bill and Code for a Telemedicine Visit During the COVID-19 Pandemic is discussed in a video by the Joint Task Force on Technology and Telemedicine. A transcript of the video is available here.