Utilize Telemedicine

Utilize Telemedicine: How does billing work?

How do I bill for a telemedicine visit?
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 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

Payer websites

  • Aetna has announced the waiver of co-pays for telehealth visits for their beneficiaries.
  • United HealthCare has announced coverage for telemedicine visits for your existing patients in commercial plans.
  • Cigna has issued guidance for interim billing procedures during COVID-19.

How do I bill for Medicare patients?
CMS has issued specific guidance for your Medicare patients and has relaxed restrictions for place of service for both physician and patients. Use standard E/M visit codes for established patients (99211-99215) or new patients (99201-99205) with place of service as 02 to indicate a telehealth visit. Your documentation must support the level of service.

How do I bill for Medicaid patients?
Rules for Medicaid patients are determined at the state level. The Center for Connected Health Policy is maintaining an updated list of state level telehealth waiver information.

What is an e-visit?
This refers to 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

Can I bill for telephone encounters?
Yes, 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 – [Telephone evaluation and management service by a physician or other qualified healthcare professional who may report evaluation and management services provided to 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; Five-10 minutes of medical discussion.]
  • 99442 – 11-20 minutes
  • 99443 – 21 minutes or more

For Medicare

  • 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. 

CODING RESOURCES

Coding for COVID-19

Special Coding Advice Related to COVID-19 from the AMA

 

See answers to How do I get started?

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