Master the 2018 Telemedicine Codes

Posted on 30 Aug, 2018 |comments_icon 0|By Elizabeth Debeasi

Are you up to speed on the 2018 CPT and HCPCS codes for telemedicine, finalized in the Medicare Physician Fee Schedule (MPFS). Read on for an overview of key updates you don’t want to miss.

HCPCS codes:

G0296 (Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan (service is for eligibility determination and shared decision making))

G0506 (Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service))

CPT® codes:

+90785 (Interactive complexity (List separately in addition to the code for primary procedure)

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)

90839 (Psychotherapy for crisis; first 60 minutes)

+90840 (Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service)).

Are telephone calls billable as a telemedicine service?

If the service you provide refers to a phone call, be aware that most payers do not recognize the following codes for payment:

  • 99441 (Telephone evaluation and management service by a physician or other qualified healthcare 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 (… 11-20 minutes of medical discussion)
  • 99443 (… 21-30 minutes of medical discussion).

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).

New for 2018, CPT® Code 99091 Unbundled

The 2018 final rule of the Medicare Physician Fee Schedule also noted that CPT® code 99091 (Collection and interpretation of physiologic data (eg, 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), which was bundled with other codes in the past, will be revalued and paid separately now.

Reporting Telehealth Service with the Appropriate Modifier

Note: New for 2018, CMS dropped the GT modifier (Via interactive audio and video telecommunication systems) and will no longer require it for telehealth claims. “CR10152 revises the previous guidance that instructed practitioners to submit claims for telehealth services using the appropriate CPT® or HCPCS code for the professional service along with the telehealth modifier GT,” noted MLN Matters release MM10152 on the subject. However, the notice advises providers to remember that “the GQ modifier [(Via asynchronous telecommunications system)] is still required when applicable.”

For Federal telemedicine demonstration programs in Alaska or Hawaii, 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.

Remember: For services you furnish on or after January 1, 2017, remember to indicate that the service your provider renders is a telehealth service from a distant site, by submitting claims for the telehealth services using the POS 02 (Telehealth).

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 their approved 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.

Master Modifier 95

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.

Important: Two of the modifier descriptors include “synchronous,” meaning in real time. The qualified provider must be using real-time audio and video telecommunications with the patient.

Place of Service (POS) Code for Distant Site

If your provider renders telehealth services to a patient you need to be aware of POS code 02 (Telehealth), that you need to report on the claim form. This POS code is described as “The location where health services and health related services are provided or received, through telecommunication technology.”

Best Practice: The location from which your provider is performing the service is the distant site while the location where the patient is receiving the service is the originating site. Remember, for Medicare telehealth services and payers that follow Medicare rules, the originating site should be an eligible facility that is located in a rural HPSA or a county outside of a MSA.

Tip: If you are the originating site, you will continue to claim for your services in the same manner as before. The POS code is not applicable to the originating site.

Important: CMS states that POS 02 is effective January 1, 2017. A CMS transmittal (R3586CP) mentions that any claims for telehealth services that include modifier GQ with the CPT® code, but do not include the POS code of 02 will be denied.

In accordance with HIPAA, non-medical code sets, like POS, are paid based on the date of the transaction, not the date of service. Therefore, if the date of service was in 2016 but you initiated the claim on or after January 1, 2017, you need to use this POS code.

Remember: This POS code is only used on the CMS-1500 claim form.

Learn More

Get you up to speed on telehealth billing, coding, denials, and everything between with The Telemedicine & Telehealth Handbook for Medical Practices.


Elizabeth Debeasi
Marketing Writer/ Editor

Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of Telehealth services.

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