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Showing posts with label Telehealth. Show all posts
Showing posts with label Telehealth. Show all posts

Telehealth Updates 2023

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 to bill the telehealth claims with the place of services indicate that the service bill under In-Person visit. And the claims must be billed with modifier 95 to indicate the service is performed in telehealth.

For Medicare adding new HCPCS codes to the list of telehealth services on a category 1, and the HCPCS codes are G0316, G0317, G0318, G3002, and G3003.

We are keeping many services that are temporarily available as telehealth services for the duration of  the COVID-19 Public Health Emergency (PHE) on a Category 3 basis through CY 2023 and including the following CPT codes.

The CPT codes are 90875, 90901, 92012, 92014, 92550, 92552, 92553, 92555-92557, 92563, 92567, 92568, 92570, 92587, 92588, 92601, 92625-92627, 94005, 95970, 95983, 95984, 96105, 96110, 96112, 96113, 96127, 96170, 96171, 97129, 97130, 97150-97158, 97530, 97537, 97542, 97763, 98960-98962, 99473, 0362T, and 0373T. 

These codes are available up to through December 31, 2023 in Medicare telehealth list.

The Category 3 CPT codes in telehealth services will be covered through 2023 and the Non-facility payment rates for telehealth services will remain the same through 2023 (physician offices are defined by Medicare as “Non-Facility” setting.

So this means telehealth payments will remain the same as in-person through 2023 and the direct supervision may continue to be provided virtually through 2023.

The CMS decided to continue paying for all of the codes on the telehealth list that were scheduled to stop 151 days after the PHE through the end of 2023.

Telehealth Originating site facility fee rate Update

The payment amount for HCPCS code Q3014 (Telehealth originating site facility fee) is 80% of the lesser of the actual charge, or $28.64 for CY 2023 services.

Other than office visit codes, the E/M visits includes following,

  • Hospital inpatient, 
  • Hospital observation, 
  • Emergency department, 
  • Nursing facility, 
  • Home services, 
  • Residence services, and 
  • Cognitive impairment assessment visits. \
For 2023, Medicare adopting the revised CPT codes for Other E/M visits (except for prolonged services)
  • G0316 for reporting prolonged hospital inpatient or observation services
  • G0317 for prolonged nursing facility services
  • G0318 for prolonged home or residence services
  • G2212, for  prolonged office/outpatient services
  • G3002 - Chronic Pain Management
  • G3003 - Chronic Pain Management 

Place of Service Updates

The place of services code is provided to pay the claims correctly at the same time the health care providers need for the specificity than Medicare for the services rendered. And the Medicare does not always need this greater the specificity to pay the claims.

The following two codes are created to meet the industry standards,

POS 02: Telehealth Provided Other than in Patient’s Home Descriptor

  • The location where health services and health related services are provided or received, through telecommunication technology. 
  • Patient is not located in their home when receiving health services or health related services through telecommunication technology. 

POS 10: Telehealth Provided in Patient’s Home Descriptor

  • The location where health services and health related services are provided or received through telecommunication technology. 
  • Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology

But the Medicare does not identified a need for new place of service code (POS 10). The MACs will instruct their providers to continue to use the Medicare billing instructions for Telehealth claims in specified under section Pub. 100-04.

Reference

Medicare Claims Processing Manual, Chapter 12, section 190. 

To see the list of telehealth codes added

Telemedicine Modifier 93 Updates'2022

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 a minimum, audio. The codes listed in Appendix T will be identified with an audio speaker symbol in the 2023 code set. The list of codes contained in the appendix, used with Modifier 93, is effective April 1, 2022.

The below summary of CPT codes that may be used for reporting audio only services when appended with Modifier 93.

The Procedures on this list involve electronic communication using interactive telecommunications equipment that includes, at a minimum, audio. The codes listed below are identified with the audio symbol.

90785 Interactive complexity (List separately in addition to the code for primary procedure)
90791 Psychiatric diagnostic evaluation
90792 Psychiatric diagnostic evaluation with medical services
90832 Psychotherapy, 30 minutes with patient
90833 Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
90834 Psychotherapy, 45 minutes with patient
90836 Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
90837 Psychotherapy, 60 minutes with patient
90838 Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
90839 Psychotherapy for crisis; first 60 minutes
90840 Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service)
90845 Psychoanalysis
90846 Family psychotherapy (without the patient present), 50 minutes
90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (eg, stuttering, cluttering)
92522 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria)
92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
96040 Medical genetics and genetic counseling services, each 30 minutes face to face with patient/family
96110 Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument
96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face to face time with the patient and time interpreting test results and preparing the report; first hour
96160 Administration of patient focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument
96161 Administration of caregiver focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument
97802 Medical nutrition therapy; initial assessment and intervention, individual, face to face with the patient, each 15 minutes
97803 Medical nutrition therapy; reassessment and intervention, individual, face to face with the patient, each 15 minutes
97804 Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes
99354 Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; first hour (List separately in addition to code for outpatient Evaluation and Management or psychotherapy service, except with office or other outpatient services [99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215])
99355 Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; each additional 30 minutes (List separately in addition to code for prolonged service)
99356 Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient or observation Evaluation and Management service)
99357 Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; each additional 30 minutes (List separately in addition to code for prolonged service)
99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
99408 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes
99409 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes
99497 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face to face with the patient, family member(s), and/or surrogate
99498 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

Documentation


The totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via face-to-face interaction.

Telehealth Update Medicare - 2022

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 after the initial 6-month in-person visit, all telehealth mental health patients must have a subsequent non-telehealth in-person visit within 12 months of the initial 6-month in-person visit date

During the initial 6-month in-person visit or during the subsequent 12-month in-person visits, if the original telehealth practitioner is unavailable for the face-to-face visit, we allow the clinician’s colleague in the same subspecialty and in the same group practice, to provide the in-person, non-telehealth service to the patient.

There are two additional modifiers for the current year in 2022 that relate to telehealth mental health services. The modifiers are, 

  • FQ - A telehealth service was furnished using real-time audio-only communication technology
  • FR - A supervising practitioner was present through a real-time two-way, audio/video communication technology
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Telehealth Updates - 2022

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 not located in their home when receiving health services or health related services through telecommunication technology.

POS 10: Telehealth Provided in "Patient’s Home"

Description: The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.

Insurance Updates

Beginning Jan. 1, Anthem and UnitedHealthcare (UHC) will require commercial and Medicare Advantage plans to use new place of service (POS) 10 for telehealth provided in the patient’s home. 

Place of service 02 should continue to be used when telehealth is provided anywhere other than a patient’s home (e.g., a hospital or skilled nursing facility). 

Mental Health Services

Reimbursement for audio-only services for mental health will continue after the public health emergency ends.

Following changes made through new federal legislation, CMS will allow audio-only services to be provided for the diagnosis, evaluation, and treatment of mental health conditions and substance use disorders after the public health emergency (PHE) ends. 

Telehealth Extended Date

UnitedHealthcare will extend the expansion of telehealth access for in-network and out-of-network providers through the national public health emergency period, currently scheduled to end April 15, 2022.

The Centers for Medicare & Medicaid Services (CMS) proposed in the 2022 Physician Fee Schedule to extend telehealth flexibilities through 2023 instead of through the end of the COVID-19 public health emergency, which is expected to run through this year.

APA supported CMS’s proposal allowing all psychological and neuropsychological testing services to be provided via telehealth after the PHE ends. 

The CMS adopted this proposal, keeping psychological and neuropsychological testing on the temporary (category 3) telehealth list through the end of 2023.

Info: Medicare does not identified a need for new place of service code 10. And the MACs will instruct their providers to continue to use the Medicare billing instructions for Telehealth claims.


Telehealth Codes

COVID-19 PHE Extension & Flu & Pneumococcal Vaccines Updates for September 2021

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
  • Cost share waivers – Treatment
  • Cost share waivers – Transportation
  • Cost share waivers – Medicare Advantage Professional Services
  • Telehealth cost share – COVID-19
  • Telehealth cost share – Non-COVID-19
  • Telehealth expansion
  • Timely filing and prescription refills
  • Referrals and provisional credentialing
  • Prior authorization

COVID-19 updates UnitedHealthcare

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. 

COVID-19 news National public health emergency extended to July 19, 2021

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 Commercial telemedicine services, as described in its telemedicine policy, will continue until further notice

For Individual Aetna Medicare Advantage members, copays are waived for in-network telehealth visits for primary care through the end of the Public Health Emergency.

Cigna

The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place until the end of Public Health Emergency (PHE) period said by Cigna

Interim accommodations for credentialing are extended through the end of the public health emergency period, currently through April 20, 2021

Humana

To support providers with caring for their Humana patients while promoting both patient and provider safety, we have updated our existing telehealth policy for the duration of the COVID-19 public health emergency (PHE)

Temporary expansion of telehealth service scope and reimbursement rules

To ease systemic burdens arising from COVID-19 and support shelter-in-place orders, Humana is encouraging the use of telehealth services to care for its members. 

Please refer to CMS, state and plan coverage guidelines for additional information regarding services that can be delivered via telehealth

Revised Guidelines for CPT 99441 - 99443

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 the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
  • 99443 - 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; 21-30 minutes of medical discussion
CMS continues did not add 98966–98968 to the telehealth list,

Other qualified health care professionals who may bill Medicare for their services, such as registered dietitians, social workers, speech language pathologists and physical and occupational therapists should use codes 98966—98968
  • 98966 - Telephone assessment and management service provided by a qualified non physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
  • 98967 - Telephone assessment and management service provided by a qualified non physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
  • 98968 - Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
New! 99441–99443 have been added to the telehealth list, so use the place of service that would have been furnished. In most cases, this will be place of service office (11) or outpatient department (19, 22). Since they are now telehealth services, add modifier 95

CMS has changed the rates for codes 99441–99443 to the rates for 99212–99214.

***Telephone codes 99441–99443 require audio only but will pay at the rates of 99212–99214 

UHC Telehealth Updates

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 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; 11-20 minutes of medical discussion
  • 99443 - 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; 21-30 minutes of medical discussion
Online digital E/M services/e-visits 
  • 99421 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
  • 99422 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
  • 99423 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
  • 98970 - Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
  • 98971 - Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
  • 98972 - Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
Virtual check Codes
  • G2010 - 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 - 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
And additional codes starting Jan. 1, 2021
  • G2250 - Remote assessment 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 service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment
  • G2251 - Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
  • G2252 - 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; 11-20 minutes of medical discussion

Audio and video visits and other services requiring video technology include,

  • The service rendered through “real-time;” a two-way, face-to-face interaction between a patient and a provider using audiovisual communications technology.
  • Office and or Outpatients CPT codes 99201 - 99215

Place Of Service 

United HealthCare initially covered the service when submitted with a place of service with modifier 95, but effective from Jan 1st, 2021, the UHC denied as the service billed with an inappropriate place of service or invalid.

The UHC shared the billing guidelines for telehealth states as following,

Starting Jan 1st, 2021, eligible telehealth service will be considered for reimbursement when reported with a place of service (POS) 02. Modifier 95, GT, GQ, GO not required and the place of service 02 will be considered the service rendered through telehealth.

Telehealth Services

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 srv 2-3 vsts p mo 12-19

90959 Esrd serv 1 vst p mo 12-19

90960 Esrd srv 4 visits p mo 20+

90961 Esrd srv 2-3 vsts p mo 20+

90962 Esrd serv 1 visit p mo 20+

90963 Esrd home pt serv p mo <2yrs

90964 Esrd home pt serv p mo 2-11

90965 Esrd home pt serv p mo 12-19

90966 Esrd home pt serv p mo 20+

90967 Esrd svc pr day pt <2

90968 Esrd svc pr day pt 2-11

90969 Esrd svc pr day pt 12-19

90970 Esrd svc pr day pt 20+

92002 Eye exam new patient

92004 Eye exam new patient

92012 Eye exam establish patient

92014 Eye exam&tx estab pt 1/>vst

92507 Speech/hearing therapy

92508 Speech/hearing therapy

92521 Evaluation of speech fluency

92522 Evaluate speech production

92523 Speech sound lang comprehen

92524 Behavral qualit analys voice

92526 Oral function therapy

92550 Tympanometry & reflex thresh

92552 Pure tone audiometry air

92553 Audiometry air & bone

92555 Speech threshold audiometry

92556 Speech audiometry complete

92557 Comprehensive hearing test

92563 Tone decay hearing test

92565 Stenger test pure tone

92567 Tympanometry

92568 Acoustic refl threshold tst

92570 Acoustic immitance testing

92587 Evoked auditory test limited

92601 Cochlear implt f/up exam <7

92602 Reprogram cochlear implt <7

92603 Cochlear implt f/up exam 7/>

92604 Reprogram cochlear implt 7/>

92607 Ex for speech device rx 1hr

92608 Ex for speech device rx addl

92609 Use of speech device service

92610 Evaluate swallowing function

92625 Tinnitus assessment

92626 Eval aud funcj 1st hour

92627 Eval aud funcj ea addl 15

93750 Interrogation vad in person

93797 Cardiac rehab

93798 Cardiac rehab/monitor

94002 Vent mgmt inpat init day

94003 Vent mgmt inpat subq day

94004 Vent mgmt nf per day

94005 Home vent mgmt supervision

94664 Evaluate pt use of inhaler

95970 Alys npgt w/o prgrmg

95971 Alys smpl sp/pn npgt w/prgrm

95972 Alys cplx sp/pn npgt w/prgrm

95983 Alys brn npgt prgrmg 15 min

95984 Alys brn npgt prgrmg addl 15

96105 Assessment of aphasia

96110 Developmental screen w/score

96112 Devel tst phys/qhp 1st hr

96113 Devel tst phys/qhp ea addl

96116 Nubhvl xm phys/qhp 1st hr

96121 Nubhvl xm phy/qhp ea addl hr

96125 Cognitive test by hc pro

96127 Brief emotional/behav assmt

96130 Psycl tst eval phys/qhp 1st

96131 Psycl tst eval phys/qhp ea

96132 Nrpsyc tst eval phys/qhp 1st

96133 Nrpsyc tst eval phys/qhp ea

96136 Psycl/nrpsyc tst phy/qhp 1st

96137 Psycl/nrpsyc tst phy/qhp ea

96138 Psycl/nrpsyc tech 1st

96139 Psycl/nrpsyc tst tech ea

96156 Hlth bhv assmt/reassessment

96158 Hlth bhv ivntj indiv 1st 30

96159 Hlth bhv ivntj indiv ea addl

96160 Pt-focused hlth risk assmt

96161 Caregiver health risk assmt

96164 Hlth bhv ivntj grp 1st 30

96165 Hlth bhv ivntj grp ea addl

96167 Hlth bhv ivntj fam 1st 30

96168 Hlth bhv ivntj fam ea addl

96168 Hlth bhv ivntj fam ea addl

96170 Hlth bhv ivntj fam wo pt 1st

96171 Hlth bhv ivntj fam w/o pt ea

97110 Therapeutic exercises

97112 Neuromuscular reeducation

97116 Gait training therapy

97129 Ther ivntj 1st 15 min

97130 Ther ivntj ea addl 15 min

97150 Group therapeutic procedures

97151 Bhv id assmt by phys/qhp

97152 Bhv id suprt assmt by 1 tech

97153 Adaptive behavior tx by tech

97154 Grp adapt bhv tx by tech

97155 Adapt behavior tx phys/qhp

97156 Fam adapt bhv tx gdn phy/qhp

97157 Mult fam adapt bhv tx gdn

97158 Grp adapt bhv tx by phy/qhp

97161 Pt eval low complex 20 min

97162 Pt eval mod complex 30 min

97163 Pt eval high complex 45 min

97164 Pt re-eval est plan care

97165 Ot eval low complex 30 min

97166 Ot eval mod complex 45 min

97167 Ot eval high complex 60 min

97168 Ot re-eval est plan care

97530 Therapeutic activities

97535 Self care mngment training

97542 Wheelchair mngment training

97750 Physical performance test

97755 Assistive technology assess

97760 Orthotic mgmt&traing 1st enc

97761 Prosthetic traing 1st enc

97802 Medical nutrition indiv in

97803 Med nutrition indiv subseq

97804 Medical nutrition group

99202 Office/outpatient visit new

99203 Office/outpatient visit new

99204 Office/outpatient visit new

99205 Office/outpatient visit new

99211 Office/outpatient visit est

99212 Office/outpatient visit est

99213 Office/outpatient visit est

99214 Office/outpatient visit est

99215 Office/outpatient visit est

99217 Observation care discharge

99218 Initial observation care

99219 Initial observation care

99220 Initial observation care

99221 Initial hospital care

99222 Initial hospital care

99223 Initial hospital care

99224 Subsequent observation care

99225 Subsequent observation care

99226 Subsequent observation care

99231 Subsequent hospital care

99232 Subsequent hospital care

99233 Subsequent hospital care

99234 Observ/hosp same date

99235 Observ/hosp same date

99236 Observ/hosp same date

99238 Hospital discharge day

99239 Hospital discharge day

99281 Emergency dept visit

99282 Emergency dept visit

99283 Emergency dept visit

99284 Emergency dept visit

99285 Emergency dept visit

99291 Critical care first hour

99292 Critical care addl 30 min

99304 Nursing facility care init

99305 Nursing facility care init

99306 Nursing facility care init

99307 Nursing fac care subseq

99308 Nursing fac care subseq

99309 Nursing fac care subseq

99310 Nursing fac care subseq

99315 Nursing fac discharge day

99316 Nursing fac discharge day

99324 Domicil/r-home visit new pat

99325 Domicil/r-home visit new pat

99326 Domicil/r-home visit new pat

99327 Domicil/r-home visit new pat

99328 Domicil/r-home visit new pat

99334 Domicil/r-home visit est pat

99335 Domicil/r-home visit est pat

99336 Domicil/r-home visit est pat

99337 Domicil/r-home visit est pat

99341 Home visit new patient

99342 Home visit new patient

99343 Home visit new patient

99344 Home visit new patient

99345 Home visit new patient

99347 Home visit est patient

99348 Home visit est patient

99349 Home visit est patient

99350 Home visit est patient

99354 Prolong e&m/psyctx serv o/p

99355 Prolong e&m/psyctx serv o/p

99356 Prolonged service inpatient

99357 Prolonged service inpatient

99406 Behav chng smoking 3-10 min

99407 Behav chng smoking > 10 min

99441 Phone e/m phys/qhp 5-10 min

99442 Phone e/m phys/qhp 11-20 min

99443 Phone e/m phys/qhp 21-30 min

99468 Neonate crit care initial

99469 Neonate crit care subsq

99471 Ped critical care initial

99472 Ped critical care subsq

99473 Self-meas bp pt educaj/train

99475 Ped crit care age 2-5 init

99476 Ped crit care age 2-5 subsq

99477 Init day hosp neonate care

99478 Ic lbw inf < 1500 gm subsq

99479 Ic lbw inf 1500-2500 g subsq

99480 Ic inf pbw 2501-5000 g subsq

99483 Assmt & care pln pt cog imp

99495 Trans care mgmt 14 day disch

99496 Trans care mgmt 7 day disch

99497 Advncd care plan 30 min

99498 Advncd care plan addl 30 min

0373T Adapt bhv tx ea 15 min

S9152 Speech therapy, re-eval

0362T Bhv id suprt assmt ea 15 min

G0108 Diab manage trn  per indiv

G0109 Diab manage trn ind/group

G0270 Mnt subs tx for change dx

G0296 Visit to determ ldct elig

G0396 Alcohol/subs interv 15-30mn

G0397 Alcohol/subs interv >30 min

G0406 Inpt/tele follow up 15

G0407 Inpt/tele follow up 25

G0408 Inpt/tele follow up 35

G0410 Grp psych partial hosp 45-50

G0420 Ed svc ckd ind per session

G0421 Ed svc ckd grp per session

G0422 Intens cardiac rehab w/exerc

G0423 Intens cardiac rehab no exer

G0424 Pulmonary rehab w exer

G0425 Inpt/ed teleconsult30

G0426 Inpt/ed teleconsult50

G0427 Inpt/ed teleconsult70

G0438 Ppps, initial visit

G0439 Ppps, subseq visit

G0442 Annual alcohol screen 15 min

G0443 Brief alcohol misuse counsel

G0444 Depression screen annual

G0445 High inten beh couns std 30m

G0446 Intens behave ther cardio dx

G0447 Behavior counsel obesity 15m

G0459 Telehealth inpt pharm mgmt

G0506 Comp asses care plan ccm svc

G0508 Crit care telehea consult 60

G0509 Crit care telehea consult 50

G0513 Prolong prev svcs, first 30m

G0514 Prolong prev svcs, addl 30m

G2086 Off base opioid tx 70min

G2087 Off base opioid tx, 60 m

G2088 Off base opioid tx, add30

G2211 Complex E/M visit add on

G2212 Prolong outpt/office vis

G9685 Acute nursing facility care





ICD 10 CM Updates

New Rules for CPT Category III T Codes

Attach the Medical Records at initial Claim Submission Please note that when submitting your initial claim for any one of the CPT codes spec...