Telemedicine visits are doctor visits for either new or established patients, only they take place on some type of live virtual platform instead of in person. The healthcare industry is beginning to more readily accept this type of doctor visit, but the billing requirements can be confusing, and reimbursement varies.
Medicare, Medicaid, and most commercial payers cover telemedicine visits, but you need to know how to bill each one to receive maximum reimbursement.
A distant site practitioner that is eligible to furnish telemedicine visits include physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, certified registered nurse anesthetists, clinical psychologists, clinical social workers, and registered dieticians or a nutritional professional.
Telehealth visits must be done in real-time communication over a system that allows interactive video and audio between the provider at a distant site and the patient at the originating medical site. An originating medical site is the location where the patient accesses the physician or practitioner through the telecommunications system (physician office, clinic, hospital, SNF, etc.). The patient must go to the originating site, unless obtaining services for which the patient’s home is considered an appropriate originating site (such as home dialysis for end-stage renal disease, or ERSD).
For commercial payers, the best course of action is typically to contact that payer and ask for their specific guidelines. Some of them require the standard Evaluation and Management (E/M) codes – 99201 – 99215 — plus a “95” modifier to signify that it was a virtual visit.
Some insurance payers may prefer the billing code 99444, which is used for an on-line consultation. However, since 99444 is such a generic code, it is being used less and less in favor of the more accurate codes (99201 – 99215) to identify the correct level of E/M along with the “95” modifier. The 2020 CPT book does not list 99444 as an option, but instead has time-specific codes:
- 99421: 5-10 minutes
- 99422: 11-20 minutes
- 99423: 21 or more minutes
Again, contacting the payers you bill is the only way to navigate the complicated telemedicine coding, especially while waiting to see if universal eligible codes are going to be decided upon as this practice becomes more widespread.
Commercial payer telemedicine visit coverage is policy-dependent, so coverage verification is needed to be certain whether virtual visits are covered for a patient.
Medicare allows several types of telemedicine visit coverage, although coding is more specific. Medicare also requires the modifier “GT” instead of “95” for all virtual visits.
Below is a partial list of eligible codes:
- 99201 – 99215: Office or other outpatient visits
- G0425 – G0427: Emergency department and inpatient consultations
- G0406 – G0408: Hospital or SNF inpatient follow-ups
- 99231 – 99233: Subsequent hospital care visits
- 99307 – 99310: Monthly nursing facility visits
- G0420 – G0421: Kidney disease education
- 90951 – 90971: ERSD management
- G0459: Pharmacologic management
- G0108 – G0109: Diabetes self-management training
- 90791 – 90792: Psychiatric management
The detailed guide is available for reference and for printing by visiting https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf.