Telemedicine billing and CPT codes for medical services

Healthcare providers of all sizes have embraced telemedicine to treat patients during the coronavirus pandemic. The Cleveland Clinic, which averaged 3,400 virtual visits a month prior to the outbreak, logged more than 60,000 telemedicine visits in March. But the surge in telemedicine usage has given healthcare providers a new thing to worry about — billing.

Traditionally, both private and public payers have been reluctant to reimburse for telemedicine services. However, during the coronavirus outbreak, the Centers for Medicare and Medicaid Services (CMS) loosened its restrictions to allow payment for more types of telemedicine visits, particularly those related to COVID-19, and private insurers followed suit.

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Even with relaxed rules, providers are still struggling to get paid. Often, the policy for telemedicine billing varies by insurance provider, and healthcare organizations aren’t getting consistent information. Policies for reimbursement are constantly evolving, and many providers are also dealing with inconsistent payment from insurance companies.

The basics of telemedicine billing

The good news is, even outside coronavirus-related services, the major private insurance companies, along with Medicare, cover telemedicine visits. That includes Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

The not so great news is that the guidelines for telemedicine billing are still evolving, and they’re not consistent across payers, including insurance companies, Medicare, and Medicaid. That means you’ll have to pay special attention to the codes you use and what the reimbursement rates are.

Common codes for telemedicine

There are some common Current Procedural Terminology (CPT) codes used for telemedicine billing, as well as Healthcare Common Procedure Coding System (HCPCS) codes to bill Medicare.

For example, a telemedicine visit with a provider, for new or established patients, could use these codes when billing Medicare:

  • 99201–99215. These codes are for office or other visits.
  • G0425–G0427. These codes are used for telehealth consultations with the emergency department or before an initial inpatient admission.
  • G0406–G0408. These codes are for follow-up inpatient telemedicine visits after a hospital stay.

There are also codes for brief, five to 10-minute check-in telemedicine visits, either online or by phone, to determine whether or not the patient needs to come in for an office visit. These are for established patients and include

  • HCPCS code G2012. This is for a brief communication, like a virtual check-in, and lasts for about five to 10 minutes.
  • HCPCS code G2010. This code is used for remote evaluation of a recorded video or images, like a teleradiology visit.

Then there are e-visits for established patients. The codes below are for visits that happen through an online portal:

  • 99421. This is a five- to 10-minute virtual visit with a physician or nurse practitioner.
  • 99422. This code is for online assessment and management from a physician or nurse practitioner for 11 to 20 minutes.
  • 99423. This code is for online evaluation and management for 21 or more minutes by a doctor or nurse practitioner.
  • G2061. The G codes are used for non-physician visits, like physical therapy sessions. This code is for a five- to 10-minute visit.
  • G2062. This code is for an 11- to 20-minute visit.
  • G2063. This code is used for a 21-minute or longer visit.

Medicare has an online fact sheet with a list of other codes that can be used for telemedicine billing.

Coronavirus-specific telemedicine billing

Since Medicare and most payers have waived copays for coronavirus-specific telemedicine visits, it’s important to make sure you’re using the right codes to get reimbursed. These codes apply to all eligible providers, including physicians, nurse practitioners, clinical psychologists, and registered dietitians, among others.

Currently, there are two new HCPCS codes to bill for coronavirus lab tests. The first code, U0001, is for testing performed specifically by Centers for Disease Control (CDC) labs. The second code, U0002, allows providers to bill for non-CDC testing for the coronavirus.

Just so you know
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The American Medical Association also created a new CPT code, 87635. This code is to be used when diagnosing a patient with the coronavirus. Labs can also use this code to bill Medicare if they’re using the method specified in the code.

As of yet no other codes specific to the coronavirus have been released. This could change, so providers that are conducting telemedicine billing need to check for updates regularly to ensure that they get paid for the services they provide.

Firm believer in personal data privacy in the age of information. Close follower of the new regulations concerning patient confidentiality & HIPAA. You can reach George through his contact form.

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