COVID-19: Correctly Billing Telehealth, Telecommunication and Telephone-only Services During the Emergency

On March 6, 2020, the Centers for Medicare & Medicaid Services (CMS) broadened access to Medicare telehealth services during the COVID-19 public health emergency (PHE) so beneficiaries can get a wider range of services from their doctors and other clinicians without traveling to a health care facility. These guidelines are effective for dates of service (DOS) on and after March 1, 2020, until the end of the designated PHE. Additionally, clinicians can provide virtual check-in services to both new and established patients.

A broad range of clinicians, including physicians, can now provide telephone-only services to their patients which were previously not covered by Medicare.

Tips for billing correctly

Providers can now provide the following services for new and established patients.

Telehealth services - Visits conducted between a provider and a patient using two-way telecommunication systems with audio and video capabilities.

  • Use of two-way, real-time interactive audio/video telecommunication capability is needed.
  • Bill professional claims for all telehealth services with DOS on and after March 1, 2020, and for the duration of the PHE to Medicare with place of service (POS) equal to what it would have been had the service been furnished in-person (example: POS 11 for office).
  • Bill appropriate covered telehealth service code(s).
  • Modifier 95 should be applied to claim lines for services furnished via telehealth.

The complete list of all Medicare telehealth services can be found at Covered Telehealth Services for PHE for the COVID-19 pandemic, effective March 1, 2020 (ZIP).

Virtual check-ins - Brief (5-10 minutes) check-ins with a provider via telephone or other telecommunications device to decide whether an office visit or other service is needed. May include remote evaluation of recorded video and/or images submitted by an established patient.

  • Healthcare Common Procedure Coding System (HCPCS) codes G2010 and G2012 may only be reported when they do not result in an in-person or telehealth visit.
  • Bill the appropriate code with the POS where the service would normally take place.
  • No modifier is required. If these services are submitted with modifier 95, the claim may deny.

Telephone-only services - Non-face-to-face E&M services provided using telephone audio only.

Current Procedural Terminology® (CPT®) codes include:

  • 98966-98968 (Non-face-to-face non-physician telephone services)
  • 99441-99443 (Non-face-to-face physician telephone services)
  • Bill the appropriate code with the POS where the service would normally take place.
  • No modifier is required. If these services are submitted with modifier 95, the claim may deny.

CMS Resources:

CMS created a video for additional guidance on telehealth and these other virtual services: Medicare Coverage and Payment of Virtual Services video.

 

            Last Updated Wed, 22 Apr 2020 19:48:19 +0000