Coronavirus Outbreak – Provider Telehealth Coding and Billing
In an effort to provide coding and billing assistance to Panacea’s clients and the provider community during this public health emergency, we have developed some general Telehealth coding and billing guidance and listing of eligible codes not only permitted for use by Medicare and Medicaid but at least two major payers (UnitedHealthcare and Blue Cross and Blue Shield).
Below you will find “Telehealth /Telemedicine at a Glance” summarizing basic guidance for providers (physician, nurse practitioner, physician assistant) billing audiovisual and audio telehealth services. Also, below is a listing of Medicare and Medicaid eligible telehealth HCPCS codes and guidance to assist the provider community in code selection. We have provided links to additional Medicaid resources where more specific coding and modifier use, benefits, FAQs and EMTALA Requirements and Implications Related to COVID-19.
Telehealth / Telemedicine at a Glance
Distant Site. The location where the physician or practitioner is at the time the professional service is provided via a telecommunications system.
Distant Site Practitioners. Physicians, nurse practitioners (NP), physician assistants (PA)
Technology
-
- Interactive audio and video telecommunications that permit real-time communication between practitioner and patient
- The exception includes asynchronous “store and forward technology” provided in single or multimedia formats
- Other methods that are non-covered are audio-only telephone consultation, text-only email message or fax – Exception during coronavirus outbreak / public health emergency
List of Telehealth services during Coronavirus CY2020
- To the extent the 1135 waiver requires established relationships HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during the public health emergency.
- For established patients only.
- Some payers may require CR modifier if audio only encounter
Code |
Medium / Long Descriptor |
Instructions for Use During Coronavirus Outbreak |
| 90791 | Psychiatric Diagnostic Evaluation | Use as applicable for behavioral patients seen virtually |
| 90792 | Psychiatric Diagnostic Eval W/Medical Services | Use as applicable for behavioral patients seen virtually |
| 90832 | Psychotherapy W/Patient 30 Minutes | Use as applicable for behavioral patients seen virtually |
| 90833 | Psychotherapy W/Patient W/E&M Srvcs 30 Min | Use as applicable for behavioral patients seen virtually |
| 90834 | Psychotherapy W/Patient 45 Minutes | Use as applicable for behavioral patients seen virtually |
| 90836 | Psychotherapy W/Patient W/E&M Srvcs 45 Min | Use as applicable for behavioral patients seen virtually |
| 90837 | Psychotherapy W/Patient 60 Minutes | Use as applicable for behavioral patients seen virtually |
| 90838 | Psychotherapy W/Patient W/E&M Srvcs 60 Min | Use as applicable for behavioral patients seen virtually |
| 90839 | Psychotherapy For Crisis Initial 60 Minutes | Use as applicable for behavioral patients seen virtually |
| 90840 | Psychotherapy For Crisis Each Addl 30 Minutes | Use as applicable for behavioral patients seen virtually |
| 90845 | Psychoanalysis | Use as applicable for behavioral patients seen virtually |
| 99201(1) | Office Outpatient New 10 Minutes | Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.) |
| 99202(1) | Office Outpatient New 20 Minutes | Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.) (3) |
| 99203(1) | Office Outpatient New 30 Minutes | Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.) (3) |
| 99204(1) | Office Outpatient New 45 Minutes | Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.) (3) |
| 99205(1) | Office Outpatient New 60 Minutes | Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.) (3) |
| 99211 | Office Outpatient Visit 5 Minutes | Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.) (3) |
| 99212 | Office Outpatient Visit 10 Minutes | Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.) (3) |
| 99213 | Office Outpatient Visit 15 Minutes | Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.) (3) |
| 99214 | Office Outpatient Visit 25 Minutes | Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.) (3) |
| 99215 | Office Outpatient Visit 40 Minutes | Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.) (3) |
| 99231 | Sbsq Hospital Care/Day 15 Minutes | Use as applicable in the hospital setting for inpatient consultations |
| 99232 | Sbsq Hospital Care/Day 25 Minutes | Use as applicable in the hospital setting for inpatient consultations |
| 99233 | Sbsq Hospital Care/Day 35 Minutes | Use as applicable in the hospital setting for inpatient consultations |
| 99421(2) | Online Digital E/M Svc Est Pt <7 D 5-10 Minutes | Eligible during coronavirus outbreak / some payers allowing use of this code |
| 99422(2) | Online Digital E/M Svc Est Pt <7 D 11-20 Minutes | Eligible during coronavirus outbreak / some payers allowing use of this code |
| 99423(2) | Online Digital E/M Svc Est Pt <7 D 21+ Minutes | Eligible during coronavirus outbreak / some payers allowing use of this code |
| 99441 | Phys/Qhp Telephone Evaluation 5-10 Min | Eligible during coronavirus outbreak / some payers allowing use of this code |
| 99442 | Phys/Qhp Telephone Evaluation 11-20 Min | Eligible during coronavirus outbreak / some payers allowing use of this code |
| 99443 | Phys/Qhp Telephone Evaluation 21-30 Min | Eligible during coronavirus outbreak / some payers allowing use of this code |
| G0406 | Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth | Eligible during coronavirus outbreak / some payers allowing use of this code |
| G0407 | Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth | Eligible during coronavirus outbreak / some payers allowing use of this code |
| G0408 | Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth | Eligible during coronavirus outbreak / some payers allowing use of this code |
| G0425 | Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth | Use as applicable for virtual ED visit |
| G0426 | Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth | Use as applicable for virtual ED visit |
| G0427 | Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth | Use as applicable for virtual ED visit |
| G0508 | Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth | Use as applicable for virtual Critical Care visit |
| G0509 | Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth | Use as applicable for virtual Critical Care visit |
| G2010(2) | Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), 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 available appointment | Eligible during coronavirus outbreak / some payers allowing use of this code |
| G2012(2) | 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 | Eligible during coronavirus outbreak / some payers allowing use of this code |
| G2061(2) | Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes | Eligible during coronavirus outbreak / some payers allowing use of this code |
| G2062(2) | Qualified nonphysician healthcare professional online assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes | Eligible during coronavirus outbreak / some payers allowing use of this code |
| G2063(2) | Qualified nonphysician qualified healthcare professional assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes | Eligible during coronavirus outbreak / some payers allowing use of this code |
| LIST OF MEDICARE TELEHEALTH SERVICES CY 2020 | ||
| 90785 | Psychotherapy Complex Interactive | |
| 90846 | Family Psychotherapy W/O Patient Present 50 Mins | |
| 90847 | Family Psychotherapy W/Patient Present 50 Mins | |
| 90951 | Esrd Related Svc Monthly & <2 Yr Old 4/> Visits | |
| 90952 | Esrd Related Svc Monthly <2 Yr Old 2/3 Visits | |
| 90954 | Esrd Related Svc Monthly 2-11 Yr Old 4/> Visits | |
| 90955 | Esrd Related Svc Monthly 2-11 Yr Old 2/3 Visits | |
| 90957 | Esrd Related Svc Monthly 12-19 Yr Old 4/> Visits | |
| 90958 | Esrd Related Svc Monthly 12-19 Yr Old 2/3 Visits | |
| 90960 | Esrd Related Svc Monthly 20&/> Yr Old 4/> Visits | |
| 90961 | Esrd Related Svc Monthly 20/>Yr Old 2/3 Visits | |
| 90963 | Esrd Svc Home Dialysis Full Month <2Yr Old | |
| 90964 | Esrd Svc Home Dialysis Full Month 2-11 Yr Old | |
| 90965 | Esrd Svc Home Dialysis Full Month 12-19 Yr Old | |
| 90966 | Esrd Svc Home Dialysis Full Month 20 Yr Old | |
| 90967 | Esrd Related Svc <Full Month <2 Yr Old | |
| 90968 | Esrd Related Svc <Full Month 2-11 Yr Old | |
| 90969 | Esrd Related Svc <Full Month 12-19 Yr Old | |
| 90970 | Esrd Related Svc <Full Month 20/>Yr Old | |
| 96116 | Neurobehavioral Status Xm Phys/Qhp 1St Hour | |
| 96150 | Hlth&Behavior Assmt Ea 15 Min W/Pt 1St Assmt | |
| 96151 | Hlth&Behavior Assmt Ea 15 Min W/Pt Re-Assmt | |
| 96152 | Hlth&Behavior Ivntj Ea 15 Min Indiv | |
| 96153 | Hlth&Behavior Ivntj Ea 15 Min Grp 2/>Pts | |
| 96154 | Hlth&Behavior Ivntj Ea 15 Min Fam W/Pt | |
| 96160 | Pt-Focused Hlth Risk Assmt Score Doc Stnd Instrm | |
| 96161 | Caregiver Hlth Risk Assmt Score Doc Stnd Instrm | |
| 97802 | Medical Nutrition Assmt&Ivntj Indiv Each 15 Mi | |
| 97803 | Medical Nutrition Re-Assmt&Ivntj Indiv Ea 15 M | |
| 97804 | Medical Nutrition Therapy Grp2/ Indiv Ea 30 Mi | |
| 99307 | Sbsq Nursing Facility Care/Day E/M Stable 10 Min | |
| 99308 | Sbsq Nursing Facil Care/Day Minor Complj 15 Min | |
| 99309 | Sbsq Nursing Facil Care/Day New Problem 25 Min | |
| 99310 | Sbsq Nurs Facil Care/Day Unstabl/New Prob 35 Min | |
| 99354 | Prolng E&M/Psyctx Svc Office O/P Dir Con 1St Hr | |
| 99355 | Prolng E&M/Psyctx Svc Office O/P Dir Con Addl 30 | |
| 99356 | Prolonged Service I/P Req Unit/Floor Time 1St Hr | |
| 99357 | Prolonged Svc I/P Req Unit/Floor Time Ea 30 Min | |
| 99406 | Tobacco Use Cessation Intermediate 3-10 Minutes | |
| 99407 | Tobacco Use Cessation Intensive >10 Minutes | |
| 99495 | Transitional Care Manage Srvc 14 Day Discharge | |
| 99496 | Transitional Care Manage Srvc 7 Day Discharge | |
| 99497 | Advance Care Planning First 30 Mins | |
| 99498 | Advance Care Planning Ea Addl 30 Mins | |
| G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes | |
| G0109 | Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes | |
| G0270 | Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes | |
| G0296 | Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making) | |
| G0396 | Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes | |
| G0397 | Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes | |
| G0420 | Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour | |
| G0421 | Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour | |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | |
| G0442 | Annual alcohol misuse screening, 15 minutes | |
| G0443 | Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes | |
| G0444 | Annual depression screening, 15 minutes | |
| G0445 | High-intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes | |
| G0446 | Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes | |
| G0447 | Face-to-face behavioral counseling for obesity, 15 minutes | |
| G0459 | Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy | |
| G0506 | Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) | |
| G0513 | Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service) | |
| G0514 | Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventive service) | |
| G2086 | Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month | |
| G2087 | Office-based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy and counseling; at least 60 minutes in a subsequent calendar month | |
| G2088 | Office-based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure) | |
Additional Medicaid and Payer Resources:
Medicaid Telemedicine
Medicaid State Plan Fee-for-Service Payments for Services Delivered Via Telehealth
Coverage and Benefits Related to COVID-19 Medicaid and CHIP
COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies
Emergency Medical Treatment and Labor Act (EMTALA) Requirements and Implications Related to Coronavirus Disease 2019 (COVID-19)