Gentem Telehealth Coding

CMS Telehealth Codes and Services

Due to the COVID-19 pandemic, federal and public-health agencies are urging consumers 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 CMS-approved telehealth codes. For more details, please check out this tool kit from CMS.

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