Telehealth (or telemedicine) is highly regulated, and as a result, has been difficult to fully adopt. Over the past week, CMS has made changes to broaden access to telehealth services.
Implementing Medicare Telehealth visits allows providers to get reimbursed at the same rate as an E/M visit.
Keep in mind that Telehealth services are available regardless of patient diagnosis; these options are not limited to treating COVID-19.
This guide is targeted at specialists that independently bill for E&M visits, and all information provided below is based on guidance from Medicare and Health and Human Services (HHS). Please consult the full documentation found at the bottom of this page if you choose to act on these recommendations.
First, it's important to understand the type of virtual services that exist:
Medicare telehealth visits are an alternative to in-person office visits (synchronous care). You must use both live audio and video except in cases when video conferencing is not available for the patient. Services are billed the same way as they would in your office, and are paid the same as well (for example, E&M codes can be used) using the POS code where the patient would have normally been seen (e.g. clinic facility code). Add the CPT Telehealth 95 modifier to these claims which will indicate the service rendered was performed via telehealth. Telehealth POS code 02 will pay at the traditional telehealth rate, not the in-person rate Medicare has temporarily authorized. Coinsurance and deductible still applies. Eye visit codes 92002, 92012, 92004 and 92014 cannot be used to report telehealth visits.
As of March 30th and until the public health emergency ends, the following changes have been put in place:
Virtual check-ins are designed to reduce unnecessary trips to your office. This is available in all areas (not just rural), and do not need to be live (asynchronous care). The patient must have an existing relationship with your practice, and the communication must not be related to an office visit within the previous 7 days and does not lead to an office visit in the next 24 hours (or next available). These services must be patient initiated, but you may need to educate patients on the availability of such service. Coinsurance and deductible still applies; patients must verbally consent to receiving these services.
There is a wide array of methods to conduct virtual check-ins: phone, audio/video, secure text messaging, secure email, or patient portal.
Use HCPCS G2012 when billing for this service and/or G2010 if you are remotely evaluating recorded video and/or images submitted by a patient.
E-visits are non face-to-face communications conducted via a patient portal. This is available in all areas (not just rural), and do not need to be live (asynchronous care). This must be conducted via a patient portal and communications can occur over a 7 day period. The patient must have an existing relationship with your practice. These services must be patient initiated, but you may need to educate patients on the availability of such service. Coinsurance and deductible still applies; patients must verbally consent to receiving these services.
Billing varies based on time: