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Telemedicine Billing Tips

Telemedicine Billing Tips. Patient holding cell phone talking to doctor.

Top Things You Should Know When Billing Telemedicine

Billing for telemedicine can be tricky, to say the least, and with the COVID-19, the coronavirus, telemedicine is changing almost on a daily basis which makes it hard to keep up.  The guidelines for billing telemedicine are still forming. In fact, the rules for billing telemedicine are not only changing rapidly but also vary from payer to payer (Medicare, Medicaid, Private payers…).

Hopefully, we’ll quickly get the point where there are clear guidelines for billing telemedicine across all payers. But medical billers need answers right now to their billing and coding questions. How should I bill telemedicine? What codes should I use? How does telemedicine reimburse? What are the restrictions I should watch out for?

Here are the top things you should know when billing telemedicine.

The major private payers all cover telemedicine

Our eVisit team has called around to the major commercial payers (Blue Cross Blue Shield, Aetna, Humana, Cigna, United Healthcare) and found that they all cover telemedicine. Medicare also covers telemedicine and with the current coronavirus crisis, the rules for telehealth have expanded.  What was not allowed last week is allowed this week.

New telemedicine rules coming out every day

Insurance companies and Medicare are updating and changing telemedicine policies almost daily. Here is an example of the new United Healthcare telemedicine policies that came out March 17, 2020. Click the link below to see the changes.

United Healthcare Provider Telehealth Policies

Here is a Summary of Medicare Telemedicine Services that also were updated on March 17, 2020. Note that Medicare now allows telemedicine visits for new patients.

Summary of Medicare Telemedicine Services

TYPE OF SERVICE WHAT IS THE SERVICE? HCPCS/CPT CODE Patient Relationship with Provider
MEDICARE TELEHEALTH VISITS A visit with a provider that uses telecommunication systems between a provider and a patient. Common telehealth services include:

  • 99201-99215 (Office or other visits)
  • G0425-G0427 (Telehealth consultations, emergency department or inpatient)
  • G0406-G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospital or SNFs)

For a complete list:

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

For new* or established patients.

*To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits that such as prior relationship existed during this public health emergency.

VIRTUAL CHECK-IN A brief (5-10 minutes) check with your practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed.  remote evaluation of recorded video and/or images submitted by an established patient.
  • HCPCS code G2012
  • HCPCS Code G2010
For established patients.
E-VISTS A communication between a patient and their provider through an online portal
  • 99431
  • 99422
  • 99423
  • G2061
  • G2062
  • G2063
For established patients.

Always verify that the patient’s insurance covers telemedicine beforehand.

The best way to ensure you can bill and get paid for telemedicine is to call and verify coverage with the patient’s insurance before their first telemedicine visit. While this takes a little work, you only have to do it once for that policy.

When you call the payer, make sure you have a telemedicine insurance verification form handy to document the representative’s answers. If you have everything documented on that form with the call reference number, you can use that later to fight a denied claim. If the payer said over the phone that telemedicine was covered and you have the reference number for the call, they have to honor that.

Know the telemedicine guidelines for each payer

This part can seem a little daunting at first, especially if you’re tackling telemedicine billing with all three of the major types of payers (Medicare, Medicaid, Private payers). For a quick overview of telemedicine guidelines, you can download our telemedicine reimbursement guide.

I’ve found the easiest way to learn what each payer wants for telemedicine is just to call and ask the right questions. Here are some of the things you should ask:

  • Which healthcare providers can bill for telemedicine?
  • What healthcare services can be done via telemedicine?
  • Do you specifically cover live video telemedicine?
  • Are there any restrictions or conditions that need to be met before a patient qualifies for telemedicine (i.e. distance from provider, established provider-patient relationship, informed patient consent in writing)?
  • Are there any restrictions on the number of telemedicine visits patients can have in a given year?

Some payers may have concrete answers to these questions that define their telemedicine coverage. Others may just say they cover telemedicine for certain providers, and not put many restrictions on it. Since these guidelines vary payer-to-payer and state-to-state, be sure to call that payer up and get their guidance.

Keep in mind, however, that since the rules are changing so fast, the representatives at the insurance carriers may not even be aware of all the changes. On top of that Medicare and the insurance companies have to update their computer systems. Don’t be surprised if your telemedicine claims get initially denied.

Ask the payer what CPT codes are eligible for billing telemedicine

We’ve found that most payers advise providers billing telemedicine to use the appropriate evaluative and management CPT code (99201 – 05, 99211-15) along with a GT or 95 modifier (more on that below).

However, Medicare covers a long list of eligible CPT codes (see full list here), and some private payers may prefer that you use the telemedicine specific code 99444. It varies based on the payer and the state you live in.

Again, the easiest way to know which codes are eligible is to call up your payer and ask. If they can’t give you a list of the covered codes, ask whether the 99444 is covered and whether you can use the E&M CPT codes with a modifier.

Know when to use the GT and 95 modifier

The GT modifier tells the Medicare payer that a provider delivered medical service via telemedicine. Medicare requires you to use a GT modifier with the appropriate Evaluative & Management CPT code when billing telemedicine.

If you bill telemedicine to a commercial insurance company you will use a regular E&M CPT code and a 95 modifier. Confirm that with the payer.

Place of service code

When billing telehealth services, healthcare providers must bill the E&M code with place of service code 02 along with a GT or 95 modifier. Telehealth services not billed with 02 will be denied by the payer. This is true for Medicare or other insurance carriers.

Know how to bill a facility fee

Most providers billing telemedicine don’t need to know about facility fees. But if you are part of a telemedicine program that bills through Medicare (and sometimes Medicaid), you should.

A facility fee is essentially an amount paid to the local healthcare facility that hosts the patient during a telemedicine visit. In the current Medicare telemedicine model for instance, a patient has to come in to an eligible originating site to start the telemedicine visit with a healthcare provider at another, distant site. That originating site can then charge a facility fee to cover the costs of hosting the visit.

To charge that facility fee, you can bill HCPCS code Q3014. Look up the HCPCS code for full details about the facility fee. You can also check out this Medicare handout for more details.

Ready to bill telemedicine? Hopefully, this gave you the basics you need to get started.

Have more telemedicine billing questions? Feel free to contact me at tiafolla@evisit.com and I’ll try my best to help you out. You can also watch eVisit’s latest webinar on telemedicine reimbursement, featuring expert medical biller Adella Cordova.

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41 thoughts on “Telemedicine Billing Tips”

  1. blank

    If my nurses are on extended calls with patients, talking about symptoms, what to do, deciding on visit with physician, etc., can I bill for a telephonic nurse visit? Obviously, I am not talking about normal, average, or run of the day calls. Thank you.

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    karen d hunter-frierson

    How do I bill for a patient that is self pay for 99442 and the edit E/M code 7days or patient seen in the next 24?

  3. blank

    Hello Teresa,
    I have a physician who had a telemedicine with a patient residing Ambassador Rehabilitation and he was located at the clinic. The call was 30 minutes and the insurance is Tricare Prime. Would this be billed with 99423 and place of service 02? Or would this be billed with a skilled nursing code? I think it would be 99423 with a GT modifier. Would you be able to assist me with this one please?

    Stella Haggas, MS Ed, CPC
    Documentation and Coding Educator

    Children’s Hospital & Medical Center
    8404 Indian Hills Drive • Omaha, NE 68114
    402.955.7104
    sthaggas@ChildrensOmaha.org

    We know children. • ChildrensOmaha.org

  4. blank
    MENTAL HEALTH BILLING SERVICES

    Thanks for the well-researched content of the blog. I really admire well-written content. I must say the facts in the blog is pretty much convincing.

  5. blank
    Christine Speroni

    ***ATTENTION***
    These rules have changed several times since this article was updated with March 17, 2020 guidelines. Please refer to CMS or your local MAC guidance and much of this information is INCORRECT!!!!

  6. blank

    Hi, This is a great in-depth post about the telemedicine system billing! Such great information. Thank you for sharing with us, I too always learn something new from your post.

  7. blank

    Hello Manny,

    How do I find the answers to the questions asked above as I am having trouble billing telephone only visits to IL Medicaid HMO plans.

  8. blank

    Hi all I would like to tell you what I’m doing. I’m using 95 as modifier now for all and pos as 11 if patient is home. Then I use the same codes I use if pt is in office. Same for phone and reimbursement for phone is same as telemedicine. They said reimbursement would be same but it’s been hit or miss. Some are even paying more.

  9. blank

    I need to transition my clinic online because of the pandemic, but I’m not sure how to figure out telehealth payments. It doesn’t help that we offer variable payments so that people can get the services that they need. Your advice to check if the insurance covers telemedicine first is really helpful. I will also start looking into a software that we can use.

  10. blank

    if anyone is in NJ billing for Workman’s comp and PIP can you please tell me if the 95 modifier is required on the telemed video billing. Thank you

  11. blank

    How do our doctors bill for consultations and subsequent visits in the hospital that are done with telemedicine? I know how to do the outpatient but how do I do the inpatients for the commercial insurances?

  12. blank

    As a medical biller During this time with COVID 19 I find myself running into some issues with reimbursement rates.

    The information on the news and resources that have been made available are providing conflicting information. The president and governor say that telehealth visits will be reimbursed at the same rate as a face to face visits. Then the provider receives payments that fall short of this statement proving it to be less than true.

    I am trying to understand and explain to the physicians in our office that when the “same rate” was stated they forgot to include the “same rate as a facility” and that it would not be the same rate as a non facility would normally receive for this face to face visit over telehealth.

    Can you please explain to me if I am misunderstanding or if the statement of “same rate as face to face” may not have applied to all providers. Such as those typically receiving a non facility rate which is higher.

    I would appreciate any assistance you can offer with this topic as it seems very unclear and want to make sure I understand correctly.

    Thank you in advance for your time.

  13. blank

    We have patients that are currently coming into our office because of chemotherapy treatments that must be administered by nursing staff. Our physician is seeing the patient via audio visual communication. We know that for the office visit we use the POS 02, but what we are unsure on is what POS do we apply to the administrations codes and medications that are completed during this same visit. Can we switch those to POS 11 since they are done in the office or do we keep them with POS 02 like the office visit. Thanks for the help.

  14. blank

    For Telehealth Inpatient hospital billing I know the CPT codes to use and the modifiers with POS 02. However do we some how need to document on the billing the Hospital the patient is located in?

  15. blank

    we see clients in home usually from perform care
    now iic’s are doing phone sessions
    do we use the same auth, codes ect.
    any help will be greatly appreciate
    sincerely,
    Maria

  16. blank

    Is it appropriate to bill POS 11 with a GT/95 modifier? My provider is in the office communicating with the patient using audio only communication for follow up care of established patients. We are only using this option during the current recommendation of the federal/state disaster declaration put into place for the Covid19 pandemic. I am not sure if this is correct or should w using POS 2??

  17. blank

    I would like to start a telemedicine service as an internist from scratch, any links please on what the best way to do it from the recommended EMR for that purpose to the billing, links from someone who done it is greatly appreciated.

  18. blank

    What are the cpt codes for telemedicine? I’m getting mixed answers from other sources that they brought out new codes Jan 2020. 99241-43, no modifier needed, and use place of service “02”.

  19. blank

    Looking to see if you know where I can find out information on of the provider is not in the office but an employee if they can teleheath with a patient who is at home and still bill for it

  20. blank

    Based on this article, you can’t use televisit for a Medicare patient from home correct?
    Patient home is not an originating site correct?

  21. blank

    My physician is telling me that another physician said you can facetime on your cell phone or skype from your computer and this is considered as telehealth, he has the patient come to his office and he facetimes them from his location and bills it . I thought you had to have telehealth software. I’m not sure this is correct but.. Can you clarify the specifics please.

  22. blank

    Thank you for this great article, I do have a question, what if a hospital uses telemedicine while the patient is treated and bills next day under a local licensed doctor who was not involved in the report/diagnostics at the time of the treatment but simply stamps the report for billing purposes. Is that even legal ?

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