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 |