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
| Category | Codes | Associated time | Medicare rate (non-facility) | Code description |
|---|---|---|---|---|
| Online Digital E/M Services | 99421 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 patient | 99201 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 patient | 99211 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 Consultation | 99446 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) | $ 37.53 | Interprofessional 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) | $ 37.53 | Interprofessional telephone/internet/EHR referral service(s) provided by a treating/requesting physician or other QHP | |
| G2010 | n/a | $ 12.27 | 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 | 5 – 10 mins | $ 14.80 | 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 | |
| Digitally stored data services/ Remote physiologic monitoring | 99453 | n/a | $ 18.77 | Remote 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 |
| 99454 | n/a | $ 62.44 | Remote 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 | |
| 99091 | Minimum of 30 mins | $ 59.19 | Collection 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 | |
| 99473 | n/a | $ 11.19 | Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration | |
| 99474 | n/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 Care | 99307 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 patient | 99334 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 care | 99231 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.
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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.
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