We have received many inquiries on the reporting of telehealth codes due to CMS reducing the restrictions on telehealth services. As of today, these reductions are available for the diagnosis and treatment of any conditions and/or diseases retroactive to March 6, 2020. While there has been communication from some commercial insurance carriers as to their reduction in restrictions also, as of this notification, it is unknown if they will follow CMS. HIS will keep you updated if new developments change the restrictions.
Medicare Telehealth Services
References:
CMS News: President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak
Medicare Telemedicine Health Care Provider Fact Sheet https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
Medicare Telehealth Frequently Asked Questions (FAQs) March 17, 2020
https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
Other Medicare Services
The following services are not considered telehealth and have always been available for Medicare patients. Some commercial insurance carriers may reimburse for these also. These services are only available for established patients.
G2010– 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.
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
Online Digital E/M Services 99421-99423
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
Telephone Services
These services are not covered by Medicare and most commercial carriers. This can be a self pay
service.
99441- Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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
99442- Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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; 11-20 minutes of medical discussion
99443- Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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; 21-30 minutes of medical discussion
Any questions or concerns please feel free to contact Lynn M. Anderanin, CPC, CPMA, CPC-I, CPPM, COSC