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 SERVICE | SERVICE DESCRIPTION | HCPCS/CPT CODE | TYPE OF PATIENT |
MEDICARE TELEHEALTH VISIT | A visit with a provider that uses telecommunication systems between a provider and a patient | Common 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-IN | A 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-VISITS | Communication between a patient and provider through an online patient portal | 99421, 99422, 99423, G2061, G2062, G2063 | Established 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