TELEHEALTH: How to Convert Your Practice Today

In recent days, we’ve all received an avalanche of emails with “COVID-19” in the subject line.  While well intended, many are too general to be useful or contain links to government sites that require hours to pore over. We’ve spent the last several days culling through the guidance, to give you practical advice you can implement right away.

Converting your practice to telehealth is the most critical step you can take right now to survive the coronavirus pandemic. The good news: it’s also a long-term investment in your practice, as COVID-19 will forever change the way doctors and patients interact.

Here’s what you need to know about providing and billing for telehealth services:

Providing Telemedicine Visits 

Virtual visits must be done on a real-time interactive platform, such as FaceTime, Skype, or Zoom.  Previously, telemedicine visits were only covered in rural areas and had to be conducted at ‘originating sites,’ but those restrictions have been lifted so that patients can receive telemedicine services in their homes. The government also waived the requirement that patients had to have been seen by the provider within the last 3 years.

Billing for Telemedicine Visits 

For most providers, billing for telemedicine services looks a whole lot like billing for in-person evaluation and management (99201 – 99215) with 2 differences: 

(1) Place of Service:
  • Medicare/Medicaid: The Place of Service for Medicare and Medicaid for telemedicine is 02. This references a location where the service is received through telemedicine technology. Do not add a modifier to the visit CPT code when billing telemedicine visits to Medicare and Medicaid; rather, make sure your Place of Service is 02.
  • Commercial: You may use Place of Service 11 (office) for payors (and change it to 02 if you receive a denial indicating the Place of Service is incorrect.  When billing to payors other than Medicare or Medicaid, you must add a modifier to the visit CPT.
(2) Modifier:There are two potential modifiers that denote a claim as telehealth: GT and 95.  We recommend you use GT and 95 for commercial payors (Aetna, Anthem BCBS, CIGNA, United, etc.), but no modifier for government payors (just the place of service 02).
  • GT Modifier:  “via interactive audio and video telecommunications systems”
  • 95 Modifier: “synchronous telemedicine services rendered via a real-time interactive audio and video telecommunications system.” (A list of codes that allow 95 are in Appendix P of the CPT code book.)

In our experience, billing an office visit in this manner will result in the same E&M office visit reimbursement that the provider would have received from the payor for a face-to-face visit. 

 

Other Online E&M Service Codes (Non-Telehealth):

There are also other codes that allow interactive communication to be billable:

(1) Telephone calls (audio only): There are existing codes for billing telephone E&M services provided by a physician or by a ‘qualified health care professional’ over the phone, capturing the time for medical discussion.
Telephone calls (audio only) Physician Medicare Allowable Non-Physician Medicare Allowable
… 5 – 10 minutes 99441 $14.52 98966 $14.52
...11 – 20 minutes 99442 $28.25 98967 $28.25
… 21 – 30 minutes 99443 $41.33 98968 $41.33

 

(2) For online “Communication-based technology” codes (i.e. email):  Codes exist for these online services provided by physicians and non-physicians. Here are the national 2020 Medicare allowables for these codes:

Online Assessment (time) Up to 7 days . . .  Physician Medicare Allowable Non-Physician Medicare Allowable
... 5 – 10 minutes 99421 $15.64 G2061 $12.33
… 11 – 20 minutes 99422 $31.23 G2062 $21.75
…21 or more minutes 99423 $50.50 G2063 $34.08

 

(3) Specialist consultations to assist the treating physician and conducted via telephone, email or EHR for an assessment and management service can also be billed.  Here are the codes and 2020 Medicare allowables:

Interprofessional Telephone/Internet/EHR assessment & mgmt Verbal and written report Medicare Allowable
..5 – 10 minutes 99446 $18.46
..11 – 20 minutes 99447 $37.29
..21 – 30 minutes 99448 $55.75
..31 minutes or more  99449 $74.25

 

If it’s a written report only that takes at least 5 minutes, the code would be 99451, and the Medicare allowable is $37.71.  If it’s ‘referral service(s) provided by a treating/requesting physician or other qualified health care professional, lasting 30 minutes,’ the code is 99452, and Medicare also allows $37.71. 

If you have questions or insights from your own telehealth billing experiences please share with us!

Marcia Brauchler is Founder and CEO of Physicians’ Ally, Inc., a billing and contracting firm based in Denver, Colorado. She helps medical practices navigate the tricky waters of coding and billing, and fight for appropriate reimbursement for their services. 

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