2020 CMS E&M Guidance Telehealth Services

As of March 17, 2020 under President Trump’s leadership, the CMS has broadened access to Medicare’s telehealth services benefits with a 1135 waiver that will pay for office, hospital and other visits furnished via telehealth starting with March 6, 2020 and lasting for the duration of the COVID-19 emergency. Prior to this waiver these benefits were very limited, this expansion ensures Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital. We anticipate changes in coding and billing on daily basis due to the Coronavirus epidemic so be sure to stay tuned.

Medicare Telemedicine Services

TYPE OF SERVICESERVICE DESCRIPTIONHCPCS/CPT CODETYPE OF PATIENT
MEDICARE TELEHEALTH VISITA visit with a provider that uses telecommunication systems between a provider and a patientCommon telehealth services include: 99201-99215 (OV or other outpatient visits) G0425-G0427 (Telehealth consultations, emergency department or initial inpatient) G0406-G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs) New or established patients
VIRTUAL CHECK-INA remote brief evaluation (5-10 minutes) check in with your practitioner via telephone or other telecommunication device to decide whether an office visit or other service may be needed. HCPCS code G2012 HCPCS code G2010 Established Patients
E-VISITSCommunication between a patient and provider through an online patient portal99421, 99422, 99423, G2061, G2062, G2063Established Patients

Traditional Medicare services for Telehealth fee-for-service (HCPCS G2010 & G2012 Physician or Qualified Healthcare Practitioner):

HCPCS code G2012 – Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

HPCS code G2010 – Remote evaluation of recorded video and/or images submitted by an established patient, including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest

E-VISITS:

Patient must generate the initial inquiry and communications can occur over a 7-day period. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. The patient must verbally consent to receive virtual check-in services. The Medicare coinsurance and deductible would apply to these services.

Medicare Part B also pays for E-visits or patient-initiated online evaluation and management conducted via a patient portal. Practitioners who may independently bill Medicare for evaluation and management visits (physicians and nurse practitioners) can bill the following codes:

  • 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes
  • 99422: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11– 20 minutes
  • 99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes.

Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes:

  • G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
  • G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes• G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
  • G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes

Ref: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

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