As telehealth services continue to evolve, look for guidance to come from your MAC
Virtual care isn’t an outlier technology anymore. In fact, connecting with patients via telehealth technology has never been so easy or so secure. So, with MACRA pushing quality, patient-focused care to the forefront of medicine, it’s no surprise that CMS put out new guidance and options to promote advancements in telehealth.
Medicare currently covers a limited number of Part B telehealth services that a Medicare beneficiary receives from an approved provider. The provider must be in an approved “originating site” location and must deliver the services through a face-to-face consult using live video conferencing technology.
Medicare pays for the following services for an approved provider to a patient located at an approved originating site. Note that telehealth services can be included as a HCPCS or CPT® code, and the code descriptor may not specific “telehealth” or “telemedicine.”
General Outpatient Care:
Health and Condition Management:
Code Correctly for Telemedicine and Telehealth
How do I know what codes to assign? The CPT® manual alone has an entire Appendix that lists the codes that you can report for telehealth services. Modifier 95 indicates that the telehealth service you are reporting is done via a real-time, interactive audio and video telecommunications system.
Remember: You can report telehealth services using CPT® and HCPCS codes.
Verify You Have the Correct Code
When your physician or qualified nonphysician practitioner (NPP) provides a telemedicine service, you need to be sure you assign the correct procedure code. Let’s review telehealth coding tips next:
Tip: If the service you provide refers to a phone call, be aware that most payers do not recognize the following codes for payment:
Tip: If the service you provide refers to an online medical evaluation, several payers will recognize and reimburse 99444 (Online evaluation and management service provided by a physician or other qualified healthcare professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network).
Check with each payer for specific payment guidelines on 99444 before filing the claim.
Tip: If you are referring to telemedicine visits where the patient is in a remote location and the provider is conducting the visit with two-way video and audio communication, you may choose from:
Medicare reimburses for these services, and other payers may also reimburse. Check with each payer for specific payment guidelines.
Use these codes for telehealth initial office visits, emergency room services, or initial inpatient visits.
Remember: There are specific requirements concerning geographic distances eligible for Medicare reimbursement under G0425-G0427. You can check all the requirements at https://www.cms.gov.
Reporting Telehealth Service with Appropriate Modifiers
Modifier GT: Submit your Medicare and Medicaid claims for telehealth services using the appropriate CPT® or HCPCS code for the telehealth service. As of Jan. 1, 2018, though, modifier GT (via interactive audio and video telecommunications systems) is not required. Instead, POS code 02 stands alone, indicating that the telehealth service meets requirements for Medicare reimbursement.
CMS reveals the descriptor to this POS code as “The location where health services and health related services are provided or received, through telecommunication technology.”
Modifier GQ: For Federal telemedicine demonstration programs in Alaska or Hawaii, you submit claims using the appropriate CPT® or HCPCS code for the professional service along with the telehealth modifier GQ if you perform telehealth services “via an asynchronous telecommunications system” (for example, 99201 GQ).
By coding and billing the GQ modifier, you are certifying that the asynchronous medical file was collected and transmitted to you at the distant site from a Federal telemedicine demonstration project conducted in Alaska or Hawaii.
You should bill the Medicare Administrative Contractor (MAC) for these covered telehealth services. Medicare will pay you the appropriate amount under the Medicare Physician Fee Schedule (PFS) for the telehealth services.
Lesson: When you are located in a CAH and reassign your billing rights to the CAH that elected the Optional Payment Method, the CAH bills the MAC for telehealth services, and the payment amount is 80 percent of the Medicare PFS for telehealth services.
The AMA introduced modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) in 2017.
Modifier 95 signifies a telehealth encounter that provides two-way, real-time audiovisual conferencing between a patient and the provider. The provider at the distant site provides healthcare services including an examination for a patient at a different location, furthermore, the patient must be an active participant in the telehealth visit.
Get you up to speed on telehealth billing, coding, denials, and everything between with The Telemedicine & Telehealth Handbook for Medical Practices.