Medical Coding Rights

The CMS released new updates in January 2023 for the medicare fee schedule summary for telehealth services.  The updates are effective from January 1, 2023 and the implemented date is January 3, 2023.  The major changes are Medicare Physician Fee Schedule and mentioned following four category and every providers, coders and billing staff knows this guidelines and changes. Telehealth originating site facility fee payment amount Expansion of coverage for colorectal cancer screening Coverage of Audiology services Other covered services The Medicare will continue to pay the telehealth service payment at same rate in person outpatient fee rate through out end of the 2023, And there is no changes and or decrease the fee rate.  And also, the Medicare will continuously paying the audio visit service CPT code 99441, 99442 & 99443 at the same rate of outpatient established office rate for the length of service/time spends with the patient. For Medicare patients, the provider would continue

The modifier 93 (Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System). Modifier 93 is a new audio-only telemedicine code that is effective on Jan. 1, 2022. Modifier 93 describes services that are provided via telephone or other real-time interactive audio-only telecommunications systems. This modifier is appropriate only if the real-time interaction occurs between a physician/other qualified health care professional and a patient who is located at a distant site. When using this modifier 93, the communication during the audio-only service must be of an amount or nature that meets the same key components and/or requirements of face-to-face interaction. Addition of Appendix T This appendix is a listing of CPT codes that may be used for reporting audio-only services when appended with Modifier 93. Procedures on this list involve electronic communication using interactive telecommunications equipment that includes, at

The listed CPT codes are covered in telehealth and changes are effective from dated on June 16, 2022 Medicare telehealth services require that the services occur over real-time audio and visual interactive telecommunications. For purposes of diagnosis, evaluation, or treatment of mental health disorders. If the patient doesn’t have the technical capacity or the availability of real-time audio and visual interactive telecommunications, or they don’t consent to the use of real-time video technology, we allow audio-only communication for telehealth mental health services to established patients located in their homes. After the PHE ends, Telehealth Mental Health services may include new or established patients so long as an in-person, face-to-face, non-telehealth service takes place within 6 months of the telehealth mental health services. This means that all telehealth mental health patients should have had a first in-person visit no later than 6 months after the PHE. After the PHE and a

Telehealth The telemedicine will be providing to improve a patient's health by permitting two-way, real time interactive audio and video communication between into the patients, and the physician or practitioner at the distant site. Requirements Two way real time interactive audio and video communication must be documented in the medical record. Type of communication -Used devices. Patient Location and Provider Location . Place of Services (POS) Changes Effective Date - January 1, 2022 Implementation Date - April 4, 2022 The place of service can be used to specify the setting information necessary to pay the claims correctly. And new place of service introduced place of service (POS 10), revised the description of POS code 02 to meet the overall industry needs. POS 02 - Telehealth Provided Other than in "Patient’s Home" Description: The location where health services and health related services are provided  or received, through telecommunication technology. Patient is

Flu & Pneumococcal Vaccines Updates for September 2021 Flu & Pneumococcal Vaccines are Expanded SNF Enforcement Discretion for Certain Pharmacy Billing effective from 09/20/2021. CMS exercised enforcement discretion for Skilled Nursing Facility (SNF) consolidated billing provisions related to flu and pneumococcal vaccines.  This allows Medicare-enrolled immunizers, including pharmacies, to bill directly and get direct reimbursement from the Medicare program (including vaccine administration and product), whether these vaccines are administered at the same time (co-administered) with a COVID-19 vaccine or at different times.  COVID-19 National Public Health Emergency Extension The U.S. Department of Health and Human Services has extended the COVID-19 national public health emergency by another 90 days.  And it was scheduled to end Oct. 17, 2021 and now it has been scheduled through Jan. 15, 2022. The extension is applicable for following services, Cost share waivers – Testing Co

Temporary cost-share waivers extended to Oct. 17, 2021 The national public health emergency has been extended from July 19, 2021, to Oct. 17, 2021. Below is an overview of how that extension affects temporary provisions for COVID-19 testing and testing-related visits. Individual Exchange, Individual and Group Market health plans:  From Feb. 4, 2020, through the national public health emergency period, UnitedHealthcare is waiving cost-sharing for in-network and out-of-network COVID-19 tests and testing-related visits. Medicare Advantage:  From Feb. 4, 2020, through the national public health emergency period, UnitedHealthcare is waiving cost-sharing for in-network and out-of-network tests for COVID-19, including testing-related telehealth visits. Medicaid:  State-specific rules and other state regulations may apply. For Medicaid and other state-specific regulations, please refer to your state-specific website or your state’s UnitedHealthcare Community Plan website. 

The national public health emergency has been extended from April 20, 2021, to July 19, 2021. Below is an overview of how that extension affects temporary provisions for COVID-19 testing and testing-related services for major payers UHC Individual Exchange, Individual and Group Market health plans: From Feb. 4, 2020 through the national public health emergency period, UnitedHealthcare is waiving cost sharing for in-network and out-of-network COVID-19 tests and testing-related services, including testing-related telehealth visits. Medicare Advantage: From Feb. 4, 2020 through the national public health emergency period, UnitedHealthcare is waiving cost sharing for in-network and out-of-network tests for COVID-19. Medicaid : State-specific rules and other state regulations may apply. For Medicaid and other state-specific regulations, please refer to your state-specific website or your state’s UnitedHealthcare Community Plan website, if applicable. Aetna Aetna’s liberalized coverage of Co

CMS will pay for phone calls using codes 99441—99443. The 4/30/20 rule adds these to the telehealth list and increased payment for these services These codes previously had a non-covered status and the  Physicians, nurse practitioners, and physician assistants should use codes 99441—99443 99441 - Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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 99442 - Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within t

The CMS fee schedule changes for audio-only codes, providers will continue to be reimbursed for audio-only visits at the rate they would receive for audio-video or in-person codes.  The CMS rates for audio-only telephonic evaluation and management (E/M) codes, as well as virtual check-ins (which may be done by telephone) and e-visits for established patients for dates of service on or after March 1, 2020. Audio-only visits and other services not requiring video technology include Audio-only (telephone) E/M services  99441 - Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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 99442 - Telephone evaluation and management s

The below list of services payable under the Medicare Physician Fee Schedule when furnished via telehealth during the PHE (Public Health Emergency) CPT Short Descriptor 77427 Radiation tx management x5 90785 Psytx complex interactive 90791 Psych diagnostic evaluation 90792 Psych diag eval w/med srvcs 90832 Psytx w pt 30 minutes 90833 Psytx w pt w e/m 30 min 90834 Psytx w pt 45 minutes 90836 Psytx w pt w e/m 45 min 90837 Psytx w pt 60 minutes 90838 Psytx w pt w e/m 60 min 90839 Psytx crisis initial 60 min 90840 Psytx crisis ea addl 30 min 90845 Psychoanalysis 90846 Family psytx w/o pt 50 min 90847 Family psytx w/pt 50 min 90853 Group psychotherapy 90875 Psychophysiological therapy 90951 Esrd serv 4 visits p mo <2yr 90952 Esrd serv 2-3 vsts p mo <2yr 90953 Esrd serv 1 visit p mo <2yrs 90954 Esrd serv 4 vsts p mo 2-11 90955 Esrd srv 2-3 vsts p mo 2-11 90956 Esrd srv 1 visit p mo 2-11 90957 Esrd srv 4 vsts p mo 12-19 90958 Esrd s