Everything You Need To Know About Telehealth Coding

Telehealth is an excellent option for reaching patients during the COVID-19 Pandemic who wouldn’t otherwise be able to come in for care. If your clinic has a Medical Doctor, PA, or Nurse practitioner, for example, they are eligible to perform Telehealth to Medicare Beneficiaries (not just rural anymore!). Medicare has recently expanded the list of Telehealth services covered to include temporary additions such as 97110 (Therapeutic exercises), 97112 (Neuromuscular reeducation), 97116 (Gait training therapy). Reference the full Medicare list here.

Medicare requires that services performed under the Telehealth Codes are performed with real-time audio-visual connection with the patient, which the ClinicDr technologies associated with our CRM connection supports and provides at no additional expense to our CRM users. If telephone is used without real-time audio-visual technology, Medicare patients should have telephone-based CPT codes billed, 99441 – 99443 or 98966-96968.

Coding requirements and coverage may vary between payers, so a thorough insurance verification is recommended with individual plans to determine if coverage exists for the plan, and if a 95 modifier should be appended and if the place of service code should be “02” for Telehealth or if the place of service code should remain for the location that the service would have normally been provided (i.e. 11 for Office location).

Medicare documentation online indicates that services normally furnished in-office but now eligible to be provided via telehealth will be reimbursed at the same rate as the prior in-office reimbursement amount. Visit the fact sheet here for details regarding Medicare Telehealth changes.

Brief check-ins for established Medicare patients are eligible now under 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 or medical discussion. Medicare states that these virtual check-ins can be conducted with a broader range of communication methods, such as telephone (do not require audio visual technologies).

Medicare provides the following telehealth coding guidelines within their fact sheet:

Everything You Need To Know About Telehealth Coding 1

For network insurances, CMS coding guidelines should be followed, unless the 3rd party payer provides payer-specific guidelines or requirements (such as with modifiers, place of service codes, etc.). Providers should always choose the service code that best fits the service being rendered and ensure that the code chosen fits with the standard of technology used for the telehealth visit with the patient (i.e. phone vs. video chat).

Chiropractors choosing to perform telehealth to serve their established patient community should always verify with the individual payer/plan if coverage for these services exists for their provider type. Medicare, for example, is not opening reimbursement for Chiropractors for telehealth but network insurances may be widening allowances for telehealth to be performed under more circumstances and for more provider types.

Recommended insurance verification questions:

  1. Are telehealth services covered for this plan when performed by a (insert type of provider here)?
  2. Are there particular modifier requirements to be appended to service codes that are performed in a telehealth environment?
  3. Should the place of service for telehealth services be 2 for telehealth submissions to this insurance carrier or should the place of service code remain as the office location?
  4. Are there any pre-authorization requirements for these codes under this patient’s plan?
  5. Can x, y, z codes be eligible for telehealth (list specific codes planned for telehealth visit) under this plan?

Document names, dates, and reference numbers related to your call. Due to these sudden COVID-19 related changes to plans and telehealth requirements, some payers may not have specific answers to all questions or representatives may not have specific answers or knowledge of how to answer all questions. In this case, rely on Medicare/CMS guidelines for billing telehealth services and educate your patient that their plan has not been able to confirm eligibility for these services with the understanding that the patient may be responsible for payment of the service if the plan determines that the service is not a covered benefit.

Other helpful resources:

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