In an effort to provide coding and billing assistance to Panacea’s clients and the provider community during this public health emergency, we have developed some general Telehealth coding and billing guidance and listing of eligible codes not only permitted for use by Medicare and Medicaid but at least two major payers (UnitedHealthcare and Blue Cross and Blue Shield).

Below you will find “Telehealth /Telemedicine at a Glance” summarizing basic guidance for providers (physician, nurse practitioner, physician assistant) billing audiovisual and audio telehealth services. Also, below is a listing of Medicare and Medicaid eligible telehealth HCPCS codes and guidance to assist the provider community in code selection. We have provided links to additional Medicaid resources where more specific coding and modifier use, benefits, FAQs and EMTALA Requirements and Implications Related to COVID-19.

Telehealth / Telemedicine at a Glance

Distant Site. The location where the physician or practitioner is at the time the professional service is provided via a telecommunications system.

Distant Site Practitioners. Physicians, nurse practitioners (NP), physician assistants (PA)

Technology

    • Interactive audio and video telecommunications that permit real-time communication between practitioner and patient
    • The exception includes asynchronous “store and forward technology” provided in single or multimedia formats
    • Other methods that are non-covered are audio-only telephone consultation, text-only email message or fax – Exception during coronavirus outbreak / public health emergency

List of Telehealth services during Coronavirus CY2020

  1. To the extent the 1135 waiver requires established relationships HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during the public health emergency.
  2. For established patients only.
  3. Some payers may require CR modifier if audio only encounter

Code

Medium / Long Descriptor

Instructions for Use During Coronavirus Outbreak

90791 Psychiatric Diagnostic Evaluation Use as applicable for behavioral patients seen virtually
90792 Psychiatric Diagnostic Eval W/Medical Services Use as applicable for behavioral patients seen virtually
90832 Psychotherapy W/Patient 30 Minutes Use as applicable for behavioral patients seen virtually
90833 Psychotherapy W/Patient W/E&M Srvcs 30 Min Use as applicable for behavioral patients seen virtually
90834 Psychotherapy W/Patient 45 Minutes Use as applicable for behavioral patients seen virtually
90836 Psychotherapy W/Patient W/E&M Srvcs 45 Min Use as applicable for behavioral patients seen virtually
90837 Psychotherapy W/Patient 60 Minutes Use as applicable for behavioral patients seen virtually
90838 Psychotherapy W/Patient W/E&M Srvcs 60 Min Use as applicable for behavioral patients seen virtually
90839 Psychotherapy For Crisis Initial 60 Minutes Use as applicable for behavioral patients seen virtually
90840 Psychotherapy For Crisis Each Addl 30 Minutes Use as applicable for behavioral patients seen virtually
90845 Psychoanalysis Use as applicable for behavioral patients seen virtually
99201(1) Office Outpatient New 10 Minutes Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.)
99202(1) Office Outpatient New 20 Minutes Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.) (3)
99203(1) Office Outpatient New 30 Minutes Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.)  (3)
99204(1) Office Outpatient New 45 Minutes Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.)  (3)
99205(1) Office Outpatient New 60 Minutes Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.)  (3)
99211 Office Outpatient Visit 5 Minutes Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.)  (3)
99212 Office Outpatient Visit 10 Minutes Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.)  (3)
99213 Office Outpatient Visit 15 Minutes Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.)  (3)
99214 Office Outpatient Visit 25 Minutes Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.)  (3)
99215 Office Outpatient Visit 40 Minutes Use as applicable for video based E/M (including Facetime, Skype, Zoom, etc.)  (3)
99231 Sbsq Hospital Care/Day 15 Minutes Use as applicable in the hospital setting for inpatient consultations
99232 Sbsq Hospital Care/Day 25 Minutes Use as applicable in the hospital setting for inpatient consultations
99233 Sbsq Hospital Care/Day 35 Minutes Use as applicable in the hospital setting for inpatient consultations
99421(2) Online Digital E/M Svc Est Pt <7 D 5-10 Minutes Eligible during coronavirus outbreak / some payers allowing use of this code
99422(2) Online Digital E/M Svc Est Pt <7 D 11-20 Minutes Eligible during coronavirus outbreak / some payers allowing use of this code
99423(2) Online Digital E/M Svc Est Pt <7 D 21+ Minutes Eligible during coronavirus outbreak / some payers allowing use of this code
99441 Phys/Qhp Telephone Evaluation 5-10 Min Eligible during coronavirus outbreak / some payers allowing use of this code
99442 Phys/Qhp Telephone Evaluation 11-20 Min Eligible during coronavirus outbreak / some payers allowing use of this code
99443 Phys/Qhp Telephone Evaluation 21-30 Min Eligible during coronavirus outbreak / some payers allowing use of this code
G0406 Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth Eligible during coronavirus outbreak / some payers allowing use of this code
G0407 Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth Eligible during coronavirus outbreak / some payers allowing use of this code
G0408 Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth Eligible during coronavirus outbreak / some payers allowing use of this code
G0425 Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth Use as applicable for virtual ED visit
G0426 Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth Use as applicable for virtual ED visit
G0427 Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth Use as applicable for virtual ED visit
G0508 Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth Use as applicable for virtual Critical Care visit
G0509 Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth Use as applicable for virtual Critical Care visit
G2010(2) Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, 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 Eligible during coronavirus outbreak / some payers allowing use of this code
G2012(2) 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 Eligible during coronavirus outbreak / some payers allowing use of this code
G2061(2) Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes Eligible during coronavirus outbreak / some payers allowing use of this code
G2062(2) Qualified nonphysician healthcare professional online assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes Eligible during coronavirus outbreak / some payers allowing use of this code
G2063(2) Qualified nonphysician qualified healthcare professional assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes Eligible during coronavirus outbreak / some payers allowing use of this code
LIST OF MEDICARE TELEHEALTH SERVICES CY 2020
90785 Psychotherapy Complex Interactive
90846 Family Psychotherapy W/O Patient Present 50 Mins
90847 Family Psychotherapy W/Patient Present 50 Mins
90951 Esrd Related Svc Monthly & <2 Yr Old 4/> Visits
90952 Esrd Related Svc Monthly <2 Yr Old 2/3 Visits
90954 Esrd Related Svc Monthly 2-11 Yr Old 4/> Visits
90955 Esrd Related Svc Monthly 2-11 Yr Old 2/3 Visits
90957 Esrd Related Svc Monthly 12-19 Yr Old 4/> Visits
90958 Esrd Related Svc Monthly 12-19 Yr Old 2/3 Visits
90960 Esrd Related Svc Monthly 20&/> Yr Old 4/> Visits
90961 Esrd Related Svc Monthly 20/>Yr Old 2/3 Visits
90963 Esrd Svc Home Dialysis Full Month <2Yr Old
90964 Esrd Svc Home Dialysis Full Month 2-11 Yr Old
90965 Esrd Svc Home Dialysis Full Month 12-19 Yr Old
90966 Esrd Svc Home Dialysis Full Month 20 Yr Old
90967 Esrd Related Svc <Full Month <2 Yr Old
90968 Esrd Related Svc <Full Month 2-11 Yr Old
90969 Esrd Related Svc <Full Month 12-19 Yr Old
90970 Esrd Related Svc <Full Month 20/>Yr Old
96116 Neurobehavioral Status Xm Phys/Qhp 1St Hour
96150 Hlth&Behavior Assmt Ea 15 Min W/Pt 1St Assmt
96151 Hlth&Behavior Assmt Ea 15 Min W/Pt Re-Assmt
96152 Hlth&Behavior Ivntj Ea 15 Min Indiv
96153 Hlth&Behavior Ivntj Ea 15 Min Grp 2/>Pts
96154 Hlth&Behavior Ivntj Ea 15 Min Fam W/Pt
96160 Pt-Focused Hlth Risk Assmt Score Doc Stnd Instrm
96161 Caregiver Hlth Risk Assmt Score Doc Stnd Instrm
97802 Medical Nutrition Assmt&Ivntj Indiv Each 15 Mi
97803 Medical Nutrition Re-Assmt&Ivntj Indiv Ea 15 M
97804 Medical Nutrition Therapy Grp2/ Indiv Ea 30 Mi
99307 Sbsq Nursing Facility Care/Day E/M Stable 10 Min
99308 Sbsq Nursing Facil Care/Day Minor Complj 15 Min
99309 Sbsq Nursing Facil Care/Day New Problem 25 Min
99310 Sbsq Nurs Facil Care/Day Unstabl/New Prob 35 Min
99354 Prolng E&M/Psyctx Svc Office O/P Dir Con 1St Hr
99355 Prolng E&M/Psyctx Svc Office O/P Dir Con Addl 30
99356 Prolonged Service I/P Req Unit/Floor Time 1St Hr
99357 Prolonged Svc I/P Req Unit/Floor Time Ea 30 Min
99406 Tobacco Use Cessation Intermediate 3-10 Minutes
99407 Tobacco Use Cessation Intensive >10 Minutes
99495 Transitional Care Manage Srvc 14 Day Discharge
99496 Transitional Care Manage Srvc 7 Day Discharge
99497 Advance Care Planning First 30 Mins
99498 Advance Care Planning Ea Addl 30 Mins
G0108 Diabetes outpatient self-management training services, individual, per 30 minutes
G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes
G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)
G0396 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes
G0397 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes
G0420 Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour
G0421 Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
G0442 Annual alcohol misuse screening, 15 minutes
G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
G0444 Annual depression screening, 15 minutes
G0445 High-intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes
G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
G0447 Face-to-face behavioral counseling for obesity, 15 minutes
G0459 Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy
G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)
G0513 Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)
G0514 Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventive service)
G2086 Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month
G2087 Office-based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy and counseling; at least 60 minutes in a subsequent calendar month
G2088 Office-based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure)

Additional Medicaid and Payer Resources:

Medicaid Telemedicine
Medicaid State Plan Fee-for-Service Payments for Services Delivered Via Telehealth
Coverage and Benefits Related to COVID-19 Medicaid and CHIP
COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies
Emergency Medical Treatment and Labor Act (EMTALA) Requirements and Implications Related to Coronavirus Disease 2019 (COVID-19)