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 Telehealth cheat sheet. 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 |
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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
Here is an overview of the things you need to know in order to get you up to speed for remote physiologic monitoring. HIGHLIGHTS Promoted by CMS Reduction in Readmission Rates Improves Patient Outcomes/Satisfaction rate Increases coordination of care opportunities Improves quality of care Recent Changes for Distant Site Physicians Telehealth can fulfill the face-to
