doctor providing a telemedicine consultation

CMS Telehealth Billing Guidelines 2022

Since the COVID-19 pandemic, more consumers have opted to use telemedicine (also known as telehealth) services to get medical care, fill prescriptions and monitor chronic conditions. Consequently, healthcare providers are experiencing a surge in demand for Telehealth services.

To help doctors and practice managers stay ahead of the curve, Gentem has put together a cheat sheet of telehealth codes approved by the Centers for Medicare and Medicaid Services (CMS). For more details, please check out this tool kit from CMS.

CMS Telehealth Codes

 
CategoryCodesAssociated timeMedicare rate
(non-facility)
Code description
Online Digital E/M Services99421
99422
99423
5-10 mins
11-20 mins
21+ mins
$ 15.52
$ 31.04
$ 50.16
Online digital E/M service for an established patient for up to 7 days, cumulative time during the 7 days. Do not use these online E/M codes on the day the physician/QHP uses codes (99201-99205)
Prolonged Services w/o Direct Patient Contact

99358

+99359

First hour

+ Each additional 30 mins

$ 113.68

+ $ 55.58

Prolonged E/M service before and/or after direct patient care. Can be used on a given day regardless of place of service. Should be used only once per date
Office/ Outpatient visit for E/M of new patient99201
99202
99203
99204
99205
10 mins
20 mins
30 mins
45 mins
60 mins
$ 46.56
$ 77.23
$ 109.35
$ 169.09
$ 211.12
– Problem focused hx and exam; straightforward medical decision making
– Expanded problem focused hx and exam; straightforward med decision
– Detailed hx and exam, low medical decision-making
– Comprehensive hx and exam, moderate medical decision-making
– Comprehensive hx and exam, high medical decision-making
Office/ Outpatient visit for E/M of established patient99211
99212
99213
99214
99215
5 mins
10 mins
15 mins
25 mins
40 mins
$ 23.46
$ 46.19
$ 76.15
$ 110.43
$ 148.33
Same as above (99201-99205), but for established patient
Inter-professional Telephone/ Internet/ EHR Consultation99446
99447
99448
99449
5 – 10 mins
11-20 mins
21-30 mins
31+ mins
$ 18.41
$ 37.17
$ 55.58
$ 73.98
Interprofessional telephone/internet/EHR assessment and management services provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other QHP. Should not be reported more than once (1X) within a 7-day interval
99451(5+ mins)$ 37.53Interprofessional telephone/internet/EHR assessment and management services provided by a consultative physician, including only a written report to the patient’s treating/requesting physician or other QHP. Should not be reported more than once (1X) within a 7-day interval
99452(30 mins)$ 37.53Interprofessional telephone/internet/EHR referral service(s) provided by a treating/requesting physician or other QHP
G2010n/a$ 12.27Remote 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
G20125 – 10 mins$ 14.80Brief 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
Digitally stored data services/ Remote physiologic monitoring99453n/a$ 18.77Remote monitoring of physiologic parameter(s) (e.g, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
99454n/a$ 62.44Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
99091Minimum of 30 mins$ 59.19Collection and interpretation of physiologic data (e.g. ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days
99473n/a$ 11.19Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration
99474n/a$ 15.16…separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified healthcare professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient
Remote physiologic monitoring treatment management services

99457

+ 99458

First 20 minutes

+ Each additional 20 mins

$ 51.61

+ $ 42.22

Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/ other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month
Subsequent Nursing Facility Care99307
99308
99309
99310
10 mins
15 mins
25 mins
35 mins
$ 44.75
$ 70.37
$ 92.75
$ 136.78
Counseling and/or coordination of care with other physicians, other QHC professionals, or agencies are provided consistent with the nature of the problems and the patient’s or families needs
Domiciliary or rest home visit for E/M of established patient99334
99335
99336
99337
15 mins
25 mins
40 mins
60 mins
$ 61.35
$ 97.08
$ 137.14
$ 197.77
Counseling and/or coordination of care with other physicians, other QHC professionals, or agencies are provided consistent with the nature of the problems and the patient’s or families needs
Subsequent hospital care99231
99232
99233
15 mins
25 mins
35 mins
$ 40.06
$ 73.62
$ 106.10
Counseling and/or coordination of care with other physicians, other QHC professionals, or agencies are provided consistent with the nature of the problems and the patient’s or families needs

Telehealth Billing Guidelines

CMS decided that certain services added to the Medicare Telehealth Services List will remain on the List until December 31, 2023. This will give CMS more time to consider which services it will permanently include on the Medicare Telehealth Services List.

Here is a summary of the updates on the CMS guidelines for telehealth billing:

  • CMS decided to extend the time period for certain services it added temporarily to the Telehealth Services List. CMS planned to withdraw these services at the end of thethe COVID-19 Public Health Emergency or December 31, 2021. Instead, CMS decided to extend that timeline to the end of 2023. 
  • CMS has also extended the inclusion of specific cardiac and intense cardiac rehabilitation codes till the end of fiscal year 2023. 
  • CMS is permanently adopting coding and payment for a lengthier virtual check-in service.
  • Section 123 of the Consolidated Appropriations Act (CAA) eliminated geographic limits and added the beneficiary’s home as a valid originating place for telehealth services provided for the purposes of diagnosing, evaluating or treating a mental health issue. 
  • Section 123 mandates that these services include an in-person, non-telehealth visit with the physician or practitioner within six months of the initial telehealth service, as well as an in-person, non-telehealth visit at least every 12 months.
  • Exceptions to the in-person visit requirement may be made depending on patient circumstances. More frequent visits are also permitted under the policy, as determined by clinical requirements on an individual basis.
  • CMS has amended the current definition of an interactive telecommunications system for telehealth services (which is defined as multimedia communications equipment that includes, at a minimum, audio and video equipment allowing two-way, real-time interactive communication between the patient and a distant site physician or practitioner) to include audio-only communications technology when used for telehealth services for the diagnosis, evaluation, or treatment of mental health problems.
  • CMS is restricting the use of an audio-only interactive telecommunications system to mental health services provided by practitioners who are capable of providing two-way, audio/video communications but the patient is unable or refuses to use two-way, audio/video technologies.
  • CMS also finalized a requirement for the use of a new modifier for services provided using audio-only communications, This verifies that the practitioner could provide two-way, audio/video technology but chose to use audio-only technology due to the patient’s preference or limitations.

Lost Revenue Calculator for Medical Billing

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Revenue Cycle Management for Telehealth Medicine

Whether you’re new to the telehealth world or a seasoned virtual care expert, it’s critical to keep track of the billing and coding changes for this evolving area of medicine. Staying on top of the CMS Telehealth Services List will help you reduce claim denials and keep a healthy revenue cycle.  ​​Revenue cycle management (RCM) ensures you have the resources you need to offer great care and meet the qualitymetrics that commercial and government payers demand.

Gentem’s cutting-edge RCM platform will give you greater control over your organization’s revenue cycle through AI-powered automation and in-depth analytics. Its real-time performance data and timely notifications provide comprehensive transparency into your claim process, ensuring that no claim is overlooked. Plus, our team of billing and revenue cycle experts can help you stay abreast of important telehealth billing changes.

Increase revenue, save time, and reduce administrative strain with our medical billing platform’s automated workflows and notifications. Book a demo today to learn more.