Most people think ‘new technology’ when they hear the term ‘telemedicine’. However, in reality, telemedicine was developed about 5 decades ago – in order to diagnose and treat patients living in remote areas. The difference between telemedicine then and today is the advancement of technology – from landline telephones in the early days to video communications today.
Telemedicine today involves virtual communication between the doctor and patient – either real time over live video or through images stored and transferred through computers and smartphones. The benefits of telemedicine are numerous and the biggest beneficiaries are those living in remote and rural locations, where access to specialists is not possible.
However, it is important to understand that telemedicine is not a separate limb of medical practice. Diagnosis and treatment through telemedicine is the same as in-house visits by a medical practitioner and thus, the reimbursement method is also the same.
In order to be eligible as a beneficiary for tele-health services, the patient has to be from designated originating sites. However, in order to avail payments, the use of real time interactive audio/video telecommunication between the beneficiary and the practitioner is a must. Evaluation, diagnosis and treatment based on stored data/images do not qualify for Medicare payments.
What is a CPT Code
Developed and maintained by the AMA, CPT (Current Procedural Terminology) codes were published for the first time in 1966. Since then, these codes are updated annually with new codes added to the thousands in existence. These CPT codes are used by medical professionals and institutions in their billing and are used by payers to determine the reimbursement for services provided.
GT Modifier
In order to receive reimbursement for telemedicine services, using just CPT codes in your billing is not enough. GT modifiers are used to indicate that the services were not face to face but virtual. GT modifiers also indicate the number of telemedicine visits that have taken place.
However, effective January 01, 2018, CMS has decided to eliminate the requirement of GT modifiers on telemedicine claims. Providers now need to provide a POS (Place of Service) 02 code on their telemedicine claims. The only exception is billing for distant site practitioners made by CAH (Critical Access Hospitals) – they are still required to use the GT modifiers in their claims.
Telemedicine CPT Codes
Given below is the list of CPT codes used for telemedicine:
| SERVICE | CPT CODE |
| Office or other outpatient visits | 99201–99215 |
| Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days | 99231–99233 |
| Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days | 99307–99310 |
| Individual and group health and behavior assessment and intervention | 96150–96154 |
| Individual psychotherapy | 90832–90834 and 90836–90838 |
| Psychiatric diagnostic interview examination | 90791 and 90792 |
| End-Stage Renal Disease (ESRD)-related services included in the monthly capitation payment | 90951, 90952, 90954, 90955, 90957, 90958, 90960, 90961 |
| End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents | 90963 |
| End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents | 90964 |
| End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents | 90965 |
| End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 20 years of age and older | 90966 |
| End-Stage Renal Disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age (effective for services furnished on and after January 1, 2017) | 90967 |
| End-Stage Renal Disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients 2-11 years of age (effective for services furnished on and after January 1, 2017) | 90968 |
| End-Stage Renal Disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients 12-19 years of age (effective for services furnished on and after January 1, 2017) | 90969 |
| End-Stage Renal Disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients 20 years of age and older (effective for services furnished on and after January 1, 2017) | 90970 |
| Individual and group medical nutrition therapy | 97802–97804 |
| Neurobehavioral status examination | 96116 |
| Smoking cessation services | 99406 and 99407 |
| Transitional care management services with moderate medical decision complexity (face-to-face visit within 14 days of discharge) | 99495 |
| Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge) | 99496 |
| Advance Care Planning, 30 minutes (effective for services furnished on and after January 1, 2017) | 99497 |
| Advance Care Planning, additional 30 minutes (effective for services furnished on and after January 1, 2017) | 99498 |
| Psychoanalysis | 90845 |
| Family psychotherapy (without the patient present) | 90846 |
| Family psychotherapy (conjoint psychotherapy) (with patient present) | 90847 |
| Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour | 99354 |
| Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes | 99355 |
| Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; first hour (list separately in addition to code for inpatient evaluation and management service) | 99356 |
| Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; each additional 30 minutes (list separately in addition to code for prolonged service) | 99357 |
| Interactive Complexity Psychiatry Services and Procedures (effective for services furnished on and after January 1, 2018) | 90785 |
| Health Risk Assessment (effective for services furnished on and after January 1, 2018) | 96160 and 96161 |
| Psychotherapy for crisis (effective for services furnished on and after January 1, 2018) | 90839 and 90840 |
Note: For ESRD-related services, a physician, NP, PA, or CNS must furnish at least one “hands on” visit (not telehealth) each month to examine the vascular access site.
Why MedConverge
While there are similarities in the codes used for face-to-face and telemedicine visits, navigating through the right codes can be a minefield. There are many commercial payers who insist on Evaluative & Management (E&M) code for telemedicine billing. Billing for traditional Medicare or Medicare Advantage patients requires you to use the CPT codes listed above. In addition there are the GT modifiers and the POS 02 codes. Our certified coders keep themselves updated on the current requirements of all types of payers– to ensure that your claims are reimbursed in full and on time.
References
- Lacktman, N. M. (2018, March 12). Telehealth Billing Compliance: Medicare Says Goodbye to the GT Modifier. Retrieved August 27, 2018, from www.healthcarelawtoday.com: https://www.healthcarelawtoday.com/2018/03/12/5118/
- Summary of Policies in the Calendar Year (CY) 2018 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, and CT Modifier Reduction List. (2017, December 7). Retrieved August 27, 2018, from www.cms.gov: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10393.pdf
- TELEHEALTH SERVICES. (2018, February). Retrieved August 27, 2018, from www.cms.gov: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/telehealthsrvcsfctsht.pdf
- What is CPT®? (2018). Retrieved August 27, 2018, from www.aapc.com: https://www.aapc.com/resources/medical-coding/cpt.aspx
