Originally published March 14, 2020. Telehealth rules changed significantly during and after the COVID-19 public health emergency, including place-of-service codes, modifiers and patient location. Payer rules change; confirm current CMS and payer requirements before billing.
Telemedicine visits are doctor visits for new or established patients that take place on a live virtual platform instead of in person. The healthcare industry is increasingly accepting this type of 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 full reimbursement.
Who can provide telemedicine visits
Distant-site practitioners 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 dietitians or nutrition professionals.
Telehealth visits must use real-time interactive audio and video between the provider at the distant site and the patient at the originating site. The originating site is where the patient accesses the practitioner, such as a physician office, clinic, hospital or SNF. The patient must go to the originating site unless the patient's home is considered an appropriate originating site for the service, such as home dialysis for end-stage renal disease (ESRD).
Commercial payers
For commercial payers, the best approach is to contact the payer and ask for its specific guidelines. Some require the standard evaluation and management (E/M) codes 99201–99215 with modifier 95 to show the visit was virtual.
Some payers may prefer code 99444 for an online consultation. Because 99444 is so generic, it is being replaced by E/M codes with modifier 95. The 2020 CPT book no longer lists 99444 and instead has time-based codes:
- 99421: 5–10 minutes
- 99422: 11–20 minutes
- 99423: 21 or more minutes
Commercial telemedicine coverage depends on the patient's policy, so verify coverage before the visit.
Medicare
Medicare covers several types of telemedicine visits, with more specific coding. Medicare requires modifier GT instead of 95 for virtual visits. 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-up
- 99231–99233: Subsequent hospital care
- 99307–99310: Nursing facility visits
- G0420–G0421: Kidney disease education
- 90951–90971: ESRD management
- G0459: Pharmacologic management
- G0108–G0109: Diabetes self-management training
- 90791–90792: Psychiatric evaluation
For the full list, see the CMS telehealth services fact sheet.