Since the COVID-19 pandemic, more consumers have opted to use telemedicine (telehealth) to get medical care, access behavioral health services and monitor chronic conditions. Consequently, healthcare providers experienced a surge in demand for telehealth appointments.
More than three years after the COVID-19 Public Health Emergency (PHE) started, telehealth looks much different now than it did pre-pandemic. This guide will provide an overview of the telehealth billing guidelines in 2023, upcoming changes, and a cheat sheet of telehealth codes approved by the Centers for Medicare and Medicaid Services (CMS).
For more details, check out this tool kit from the CMS.
Telehealth Billing Guidelines 2023
Before the PHE, telehealth was not as accessible as it is today. Medicare patients, in particular, didn’t have a lot of telehealth flexibility due to strict rules outlined by the CMS. Patients typically had to travel to a physical location for care, including behavioral/mental health care.
During the pandemic, the CMS eased some of those restrictions to help accommodate the surge in telehealth interest. For example, Medicare added more than 100 codes for telehealth care during the PHE. These fee-for-service telehealth visits are paid at the same rate as an in-person visit for the duration of the PHE. This rate will continue through the end of 2023.
'95' Modifier for Telehealth
As has been the practice for the last couple of years, you should continue to bill telehealth visits with the place of service you would use if it were an in-person visit. But don’t forget to use the “95” modifier to indicate it was a telehealth appointment. This guideline will be in place through 2023.
Permanent Medicare Telehealth Changes
Although the PHE will expire in May 2023, CMS has made some telehealth changes permanent. Many of these changes focus on mental health care, including:
- There are no geographic restrictions for originating sites for behavioral/mental telehealth services.
- Clinicians can use audio-only telehealth to provide behavioral/mental health services.
- Medicare patients can receive behavioral/mental telehealth services in their homes.
- Rural health clinics and federally qualified health centers can serve as distant site providers for behavioral/mental health care.
- Rural hospital emergency departments can be an originating site.
Temporary Medicare Telehealth Changes
Other changes made during the PHE remain temporary, but the omnibus bill passed at the end of 2022 extended many of them through December 31, 2024. In particular, Medicare patients can continue to receive telehealth services for specific care outlined in the 2023 Medicare Physician Fee Schedule. Other temporary changes that will last through 2024 include:
- Speech-language pathologists, physical therapists, audiologists and occupational therapists can provide care via telehealth.
- Clinicians can deliver some non-behavioral/mental health services via audio-only telehealth.
- There are no geographic restrictions for originating sites for non-behavioral/mental health services.
Two temporary changes will end once the PHE ends in May.
- Medicare-covered providers can use any non-public-facing application to communicate with patients without risk of federal penalty, even if the application isn’t HIPAA-compliant.
- Telehealth can be provided as an excepted benefit.
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Telehealth Code Cheat Sheet
Below are some common telehealth CPT codes and the non-facility, national Medicare rate. You can also access a list of telehealth services for 2023 from the CMS.
Category | Codes | Associated time | Medicare rate (non-facility, national rate) | Code description |
Online Digital E/M Services | 99421 99422 99423 | 5-10 mins 11-20 mins 21+ mins | $ 14.91 $ 29.48 $ 47.10 | 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) |
Office/ Outpatient visit for E/M of new patient | 99202 99203 99204 99205 | 20 mins 30 mins 45 mins 60 mins | $ 72.86 $ 112.84 $ 167.40 $ 220.95 |
|
Office/ Outpatient visit for E/M of established patient | 99211 99212 99213 99214 99215 | 5 mins 10 mins 15 mins 25 mins 40 mins | $ 23.38 $ 56.93 $ 90.82 $ 128.43 $ 179.94 | 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 | $ 17.96 $ 35.58 $ 54.22 $ 71.84 | 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) | $ 35.58 | 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) | $ 33.21 | Interprofessional telephone/internet/EHR referral service(s) provided by a treating/requesting physician or other QHP | |
G2010 | n/a | $ 12.20 | 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 | $ 14.23 | 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 | $ 19.32 | 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 | $ 50.15 | 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 | $ 54.22 | 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 | $ 12.88 | Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration | |
99474 | n/a | $ 15.25 | …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 | $ 48.80 + $ 39.65 | 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 30 mins 45 mins | $ 39.65 $ 74.55 $ 106.75 $ 153.51 | 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 | 25 mins 35 mins 50 mins | $ 49.81 $ 79.30 $ 119.28 | 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 |
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 quality metrics 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 reimbursement process, ensuring that we don’t overlook any claims. Plus, our team of billing and revenue cycle experts can help you stay abreast of important telehealth billing changes.
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