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 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

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. (Updated 6/16/20)
• Cigna has issued guidance for interim billing procedures during COVID-19. (Updated 6/1/20)
• Additional commercial payer information may be found here. Please note: The AAAAI is providing this link as a resource, but remember each patient’s coverage must be verified independently.  

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 indicated as where the patient would have been seen if the services were provided in person. For most allergy practices this is 11, but for those who work at a University, it may be outpatient for the location. Your documentation must support the level of service.
Additional information can be found in this helpful video from CMS. 

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 – Five-10 minutes of medical discussion
• 99442 – 11-20 minutes of medical discussion
• 99443 – 21 minutes or more of medical discussion

For Medicare

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.

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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