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.
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.
|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:
For a complete list:
|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.||
||For established patients.|
|E-VISTS||A communication between a patient and their provider through an online portal||
||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 firstname.lastname@example.org 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.