- Please note a variety of effective dates have been referenced regarding the use of the code below specifically related to COVID-19. Therefore, the recommendation is to retroactive their use to March
6, 2020. - The provider must use an interactive audio and video telecommunications system that permits real-time communication between you at the distant site, and the beneficiary at the originating site.
- Transmitting medical information to a physician or practitioner who reviews it later is permitted only in Alaska or Hawaii Federal telemedicine demonstration programs.
- Best practice suggests that documentation should also include a statement of the method of telehealth service performed, consented from the patient to receive the services provided through telehealth, and both the location, names and roles of
any person participating in the telehealth service (patient, provider, other).Recommendation:
Audio & Video
“ This service was provided through telehealth, audio & video. The patient has consented to proceed with this telehealth service. The patient located at
***(
location of the patient
)
and this writer located at***(
location of the provider
)
[if applicable –
and the other parties of ***(
names and roles of any other persons participating in the telehealth services
)”Telephone Only
“ This service was provided through telehealth, telephone only. The patient has consented to proceed with this telehealth service. The patient located at ***(
location of the patient
) and this writer located at***(
location of the provider
)
[if applicable – and the other parties of ***(
names and roles of any other persons participating in the telehealth services
)
]
”
CY 2020 Medicare Telehealth Services / Service |
HCPCS/CPT Code |
Medicare Telehealth Visits |
|
Office or other outpatient visits |
99201 – 99215 |
Telehealth consultations, emergency department or initial inpatient |
G0425 – 30 min G0426 – 50 min G0427 – 70 min |
Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs |
G0406 – Limited, 15 min G0407 – Intermediate, 25 min G0408 – Complex, 35 min |
Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge) |
99496 |
Advance Care Planning, 30 minutes |
99497 |
Advance Care Planning, additional 30 minutes |
99498 |
Psychoanalysis |
90845 |
Family psychotherapy (without the patient present) |
90846 |
Family psychotherapy (conjoint psychotherapy) (with patient present) |
90847 |
Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient(could include caregiver/family) each 30 minutes; individual patient |
98960 |
Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 2-4 patients |
98961 |
Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5-8 patients |
98962 |
Counseling visit to discuss need for lung cancer screening using low dose CT scan (LDCT) (service is for eligibility determination and shared decision making |
G0296 |
Interactive Complexity Psychiatry Services and Procedures |
90785 |
Health Risk Assessment |
96160, 96161 |
Comprehensive assessment of and care planning for patients requiring chronic care management (This is an add-on code to be used with another E/M service (the chronic care management initiating visit, which can be the AWV/IPPE or a qualifying face-to-face E/M visit) |
G0506 |
Psychotherapy for crisis |
90839, 90840 |
Office-Based treatment for opioid disorder |
G2086 – 70 min in 1st month G2087 – 60 mins G2088 – each add’l 30 min |
Group psychotherapy |
90853 |
Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first |
99457 |
Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each |
99458 |
Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (List separately in addition to the code for primary procedure) |
90863 |
Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral |
92227 |
Remote imaging for monitoring and management of active retinal disease (eg, diabetic retinopathy) with physician review, interpretation and report, unilateral orbilateral |
92228 |
External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient days; review and interpretation with report by a physician or other qualified health care professional |
93228 |
External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient professional |
93229 |
External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, |
93268 |
External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; recording (includes connection, |
93270 |
External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; transmission and analysis |
93271 |
External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; review and interpretation |
93272 |
Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family |
96040 |
Psychological testing evaluation – physician/QHP 1st hour |
96130 |
Psychological testing evaluation – physician/QHP ea add’l hour |
96131 |
Neuropsychological testing evaluation – physician/QHP 1st hour |
96132 |
Neuropsychological testing evaluation – physician/QHP ea add’l hour |
96133 |
Psychological or neuropsychological test administration and scoring, physician/QHP 1st 30 min |
96136 |
Psychological or neuropsychological test administration and scoring, physician/QHP ea add’l 30 min |
96137 |
Psychological or neuropsychological test administration and scoring, technician 1st 30 min |
96138 |
Psychological or neuropsychological test administration and scoring, technician ea add’l 30 min |
96139 |
Health behavioral assessment/reassessment |
96156 |
Health behavioral intervention, individual 1st 30 min |
96158 |
Health behavioral intervention, individual each add’l 15 min |
96159 |
Health behavioral intervention, group 1st 30 min |
96164 |
Health behavioral intervention, group ea add’l 15 min |
96165 |
Health behavioral intervention, family 1st 30 min |
96167 |
Health behavioral intervention, family ea add’l 15 min |
96168 |
Speech/hearing therapy |
92507 |
Evaluation of speech fluency |
92521 |
Evaluation speech production |
92522 |
Evaluation of speech sound production; with evaluation of language comprehension and expression |
92523 |
Behavioral and qualitative analysis of voice and resonance |
92524 |
Therapeutic exercises |
97110 |
Neuromuscular reeducation |
97112 |
Gait training therapy |
97116 |
PT Eval low complex 20 min |
97161 |
PT Eval mod complex 30 min |
97162 |
PT Eval high complex 45 min |
97163 |
PT re-eval est plan care |
97164 |
OT eval low complex 30 min |
97165 |
OT eval mod complex 45 min |
97166 |
OT eval high complex 60 min |
97167 |
OT re-eval est plan care |
97168 |
Self care management training |
97535 |
Physical Performance Test |
97750 |
Assistive Technology Assess |
97755 |
Orthotic mgmt&training 1st enc |
97760 |
Prosthetic trainingg 1st enc |
97761 |
Radiation treatment management, 5 treatments |
77427 |
Reporting Contact Only |
ICD-10 |
|||
Contact with and (suspected) exposure to other viral communicable diseases should be reported if the patient has had contact with someone who has tested positive, but the patient has no signs/symptoms. |
Z20.828 |
|||
Reporting Observation Only |
ICD-10 |
|||
Encounter for observation for suspected exposure to other biological agents ruled out should be used if the patient is being observed for what is thought to be COVID-19 but the test was negative, or it was ruled out. In this case it is Note: if another definitive diagnosis is reported instead, then that would take the place of Z03.818. |
Z03.818 |
|||
Reporting a Confirmed Case |
ICD-10 |
|||
COVID-19 and Sequencing Guidelines After April 1, 2020
|
||||
Definitive Diagnosis |
Before April 1, 2020 |
After April 1, 2020 |
||
With Pneumonia If the pneumonia is confirmed as being due to a confirmed case of COVID-19, code: |
J12.89, Other viral pneumonia B97.29 Other coronavirus as the cause of diseases classified elsewhere |
U07.1, COVID-19 J12.89, Other viral pneumonia |
||
With Acute Bronchitis If the bronchitis is confirmed as being due to a confirmed case of COVID-19, code: |
J20.8 Acute bronchitis due to other specified organisms B97.29 Other coronavirus as the cause of diseases classified elsewhere |
U07.1, COVID-19 J20.8 Acute bronchitis due to other specified organisms |
||
With Lower Respiratory Infection If the lower respiratory infection is confirmed as being due to a confirmed case of COVID-19, code: |
J22 Unspecified acute lower respiratory infection, not otherwise specified B97.29 Other coronavirus as the cause of diseases classified elsewhere. (Alternatively, if they state that it is another type of respiratory infection (not included in other coding options) then you would use J98.8 (other specified respiratory disorders) with B97.29. |
U07.1, COVID-19 J22 Unspecified acute lower respiratory infection, not otherwise specified (Alternatively, if they state that it is another type of respiratory infection (not included in other coding options) then you would use J98.8 (other specified respiratory disorders) |
||
With ARDS (Acute Respiratory Distress Syndrome) |
J80 Acute respiratory distress syndrome B97.29 Other coronavirus as the cause of diseases classified elsewhere. |
U07.1, COVID-19 J20.8 Acute bronchitis due to other specified organisms |
||
Signs & Symptoms |
||||
For patients presenting with any signs/symptoms (such as fever, etc.) and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as: Cough, Shortness of breath, Fever, unspecified |
R05 Cough R06.02 Shortness of breath R50.9 Fever, unspecified |
|||
Modifiers (Note: May be needed for specific payers) |
Modifier |
CMS |
Medicaid |
Commercial |
Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System (Note – Appendix P of AMA CPT book provides list of “CPT Codes That May Be Used for Synchronous Telemedicine Services”) |
95 |
Yes |
State Specific |
Varies by payor |
Via interactive audio and video telecommunication systems |
GT |
Telephone Only=Yes |
State Specific |
Varies by payor |
State specific Modifiers indicating Telehealth services |
U1 – UD |
State Specific |
Varies by payor |
|
Catastrophe/disaster related (Professional) |
CR |
State Specific |
Varies by payor |
|
Place of Service (POS) Codes (Note Medicare, Ky Medicaid Use 02, Not Modifier GT) |
||||
POS codes are different by payor, by method that the services were provided; Audio & Video, Telephone Only Standard – use the typical POS code you would have provided to the patient were the visit have been normally face-to-face.
Audio & Video = AV |
AV = Standard T = 02 |
State Specific |
Varies by payor |
Resources:
-
CMS Medicare Learning Network, Telehealth Services, MLN Booklet ICN 901705, January 2019
-
Centers for Disease Control (CDC) – “Coding guidance has been developed by CDC and approved by the four organizations that make up the Cooperating Parties: the National Center for Health Statistics, the American Health Information
Management Association, the American Hospital Association, and the Centers for Medicare & Medicaid Services”. – for the ICD-10 information
State/ Professional Entity |
Source |
Notes |
CMS |
https://www.cms.gov/files/document/covid-final-ifc.pdf |
3/30/2020 |
Kentucky |
https://kytelecare.med.uky.edu/kytelecare-ky-tele-health-network-policies |
|
North Carolina |
https://medicaid.ncdhhs.gov/blog/2020/03/13/special-bulletin-covid-19-2-general-guidance-and- policy-modifications |
|
New Hampshire |
https://www.nh.gov/insurance/legal/documents/nhid-order-health-insurer-coverage- coronavirus.pdf |
|
|
||
Maine |
https://www11.anthem.com/shared/noapplication/f0/s0/t0/pw_g396592.pdf?refer=ahpmedprovider |
Anthem Maine Health |
Maine |
Section 4 Telehealth Services |
|
Virginia |
||
Virginia |
https://law.lis.virginia.gov/vacode/title38.2/chapter34/section38.2-3418.16/ |
|
Virginia |
https://lis.virginia.gov/cgi-bin/legp604.exe?201+sum+HB1332S |
|
American Academy of Family Practice |
https://www.aafp.org/journals/fpm/blogs/gettingpaid/entry/coronavirus_testing_telehealth.html |
Legislation |
NAMAS |
https://www.ensemblehp.com/wp-content/uploads/attachments/there-is-a-pandemic.pdf |
telehealth-telemedicine-services-guide—all-methods-april2020.pdf