Medicare Telehealth Services
Telehealth Services Basics
Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health. Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. CMS has expanded this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. The benefits are part of the broader effort by CMS to contain the community spread of this virus.
Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients.
Medicare beneficiaries will be able to receive a specific set of services through telehealth including evaluation and management visits (common office visits), mental health counseling, and preventive health screenings. There are three main types of virtual services physicians and other professionals can provide to Medicare beneficiaries: Medicare telehealth visits, virtual check-ins, and e-visits.
MEDICARE TELEHEALTH VISITS
- Currently, Medicare patients may use telecommunication technology for office, hospital visits and other services that generally occur in-person.
- These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
- While they must generally travel to or be located in certain types of originating sites such as a physician’s office, skilled nursing facility or hospital for the visit, Medicare will make payment for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.
- The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
- CMS expects that these virtual services will be initiated by the patient. The patient must verbally consent to receive virtual check-in services.
- These virtual check-ins care for patients with an established (or existing) relationship with a physician.
- This is not limited to only rural settings or certain locations.
- The Medicare coinsurance and deductible would generally apply to these services.
- HCPCS code G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, 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.
- The practitioner may respond to the patient’s concern by telephone, audio/video, secure text messaging, email, or use of a patient portal.
- Standard Part B cost-sharing applies to both. In addition, separate from these virtual check-in services, captured videos or images can be sent to a physician (HCPCS code G2010).
- The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. The patient must verbally consent to receive virtual check-in services. The Medicare coinsurance and deductible would apply to these services.
- Medicare Part B also pays for E-visits or patient-initiated online evaluation and management conducted via a patient portal. Practitioners who may independently bill Medicare for evaluation and management visits (for instance, physicians and nurse practitioners) can bill the following codes:
- 99421 CPT Code: Online digital evaluation and management service, for an established patient, for up to 7 days, a cumulative time during the 7 days; 5–10 minutes
- 99422 CPT Code: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes
- 99423 CPT Code: Online digital evaluation and management service, for an established patient, for up to 7 days, a cumulative time during the 7 days; 21 or more minutes.
- Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech-language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes:
- G2061 CPT Code: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, a cumulative time during the 7 days; 5–10 minutes
- G2062 CPT Code: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, a cumulative time during the 7 days; 11–20 minutes
- G2063 CPT Code: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, a cumulative time during the 7 days; 21 or more minutes.
CPT © Copyright 2021 American Medical Association
Worried about getting reimbursement for telehealth services? Hopefully, this article gave you a Medicare covered Telehealth/Telemedicine services you need to get started. Stay connected for more articles on telehealth billing services. For any enquires on medical billing for telehealth/telemedicine services, feel free to call E2E Medical Billing Services at 888-552-1290 or write to us at [email protected]