Telehealth Guide

We received many questions on how to best approach telehealth.

In classic American healthcare fashion, the telehealth landscape is full of opportunity yet totally fragmented. Different payers have rules that change by plan. The rules vary by state and are changing daily. While there are a few broad rules you can follow for some plans, we recommend you verify patient eligibility individually for anyone who falls outside these clear rules. We can help with this.

This guide summarizes different approaches a practice can take to be successful with telehealth. We’ve included all of our source material so you can read deeper if you please. Before getting started, it is best to be clear on your goal. You can:

  • Replace office, hospital, or nursing home visits with virtual check-ins. As of, 3/17/2020 Medicare allows these visits to happen via Skype or Facetime. You can access Medicare’s latest update here

  • Use Medicare’s new non-face-to-face codes (99421-99423) to bill for 5, 10, 20+ minutes speaking to a patient over the span of a week.

  • Bill higher level CCM visits. This could become a source of reoccurring revenue for your practice during quarantine days. Many of you already have experience billing the lowest level CCM codes. There are several more.

Before performing any telehealth, you must receive consent from the patient. Many states accept verbal consent documented in the record. New Jersey accepts this, Texas does not.

 

Virtual Check-Ins

Procedure Codes:

Standard E&M codes (99212-99215, 99232-99233*, 99307-99310*)  billed with specific modifiers and a different place of service.  There are also a few telehealth specific codes which can be billed. We will sort out the modifiers for you. When you bill a telehealth visit, please make sure to tell us it is a telehealth visit using the notes feature on the billing screen. 

Reimbursement:

Many states (NJ & Texas included) have parity laws where telehealth must be paid the same as an in-person encounter.

Caveats:

 

Short Phone Check-Ins

Procedure Codes: 

99421-99423

G2061 – G2063 (qualified non-physicians) 

Reimbursement:

Medicare pays $12 – $41 for these codes. Aetna Horizon BCBS, Humana, UHC, and Oxford have confirmed they will reimburse the same. 

Code Descriptions:

99421- 99423 can be used for 5-10, 11-20, or 21+ minutes of time in a week respectively. Here is the description for a 5-10 minute check-in.

Online digital evaluation and management service, for an established patient, for up to 7 days, the cumulative time during the 7 days; 5-10 minutes On-line medical evaluation services are non-face-to-face encounters originating from the established patient to the physician or other qualified health care professional for evaluation or management of a problem utilizing internet resources. The service includes all communication, prescription, and laboratory orders with permanent storage in the patient’s medical record.

The service may include more than one provider responding to the same patient and is only reportable once during seven days for the same encounter. Do not report these codes if the online patient request is related to an E/M service that occurred within the previous seven days or within the global period following a procedure. Report 99421 if the cumulative time during the seven-day period is five to 10 minutes; 99422 for 11 to 20 minutes; and 99423 for 21 or more minutes.

These codes are used to report non-face-to-face patient services initiated by an established patient via an online inquiry. Providers must provide a timely response to the inquiry and the encounter must be stored permanently to report this service. These services are reported once in a seven-day period and are reported for the cumulative time devoted to the service over the seven days. The cumulative time of less than five minutes should not be reported. A new/unrelated problem initiated within seven days of a previous E/M visit that address a different problem may be reported separately. Medicare and other payers may not reimburse separately for these services. Check with the specific payer to determine coverage.

G2061 – G2063- Same description as 99421-99423, but a non-phyisican. 

Caveats:

  • Unlike other telehealth codes, these codes do not require a video component

  • There seems to be a little room for interpretation on how to approach this part of the code description of 99421-9923: “non-face-to-face patient services initiated by an established patient via an on-line inquiry” our patient portal is available if you choose to use it.

  • While Medicare has started to reimburse for this, different payers will have different rules.

  • Please speak with us to determine the best documentation workflow for your practice

 

Chronic Care Management 

Procedure Codes:

99490, 99491, 99487, 99489

Reimbursement:

$31 – $75

Caveats:

  • These services are limited to only Medicare and Medicare HMO patients

  • We’ve noticed that CCM is typically left to the domain of medical assistants. To bill the higher-level codes, we recommend a bit more provider involvement. However, it is important to note that you can bill these codes for just general supervision, so the time spent can be by anyone in your office

  • You cannot bill any screenings in conjunction with CCM, those can only be done with E&M codes

  • You must get a verbal consent to bill CCM for a patient

  • CCM codes are typically billed by primary care physicians

  • You do not need any additional technology to bill CCM codes. You just need to get CCM consent once. You can proactively reach out to patients and bill this each month!

Please let us know how we can help you through this difficult time.