Wiki Televisit updates

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gayle89@gmail.com

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As per 2025 updates we have new range of CPTs 98000 - 98016 for audio and audio with video tele-visits. (i) Are these (98000–98007) substitute codes for 99202- 99215 with GT/95 modifiers (audio with video visits)? (ii) Does Medicare accept all these tele visit codes? (iii) can we still use 99202-99215 code sets with 95/GT modifier in 2025? (iv) Do we need to use 93 modifier for audio televisits (98008–98015)? Kindly share related CMS articles for televisits and articles for commercial insurance.

Thanking you in advance.
 
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Hi there,
i. If you have a payer that accepts the 980## codes you should use them instead of the office/other outpatient codes.
ii. No. CMS assigned the audio/video and audio-only codes (98000-98015) a status indicator of I (invalid0 for 2025. The only code Medicare will cover is 98016, the virtual check in code that should be reported in place of G2012. See the quote from the final rule below.
iii. For Medicare you should use the appropriate place of service (02 or 10) based on where the patient is located at the time of the encounter.
iv. The 2025 final rule states:
We do not believe that there is a programmatic need to recognize the audio/video and audio-only telemedicine E/M codes for payment under Medicare. We proposed to assign CPT codes 98000-98015 a Procedure Status indicator of “I”, meaning that there is a more specific code that should be used for purposes of Medicare, which in this case would be the existing office/outpatient E/M codes currently on the Medicare telehealth services list when billed with the appropriate POS code to identify the location of the beneficiary and, when applicable, the appropriate modifier to identify the service as being furnished via audio-only communication technology.
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Until March 31st, we are to use regular EM codes with Mod 93 for audio only visits. Does that mean we can determine the level of service with MDM OR time? Or just time like the old telephone codes (99441-99443)?
 
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cynthiakatherine said:
Until March 31st, we are to use regular EM codes with Mod 93 for audio only visits. Does that mean we can determine the level of service with MDM OR time? Or just time like the old telephone codes (99441-99443)?
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Hi there, yes you can use MDM or time to report office/outpatient codes reported via telehealth.
 
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cynthiakatherine said:
Thank you! That's what I thought but I can't find that in print anywhere. Do you happen to have a source?
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Hi there, unless your MAC has addressed this I don't think you will find an official source that specifically states that. The best I can recommend is reading the sections on telehealth and the new 980## codes in the final rule to see that Medicare did not change the rules for leveling office/outpatient visits. https://www.federalregister.gov/doc...es-under-the-physician-fee-schedule-and-other If it was going to do so it would have had to put it in the proposed rule.

Keep in mind that office/outpatient codes could be reported by telehealth before the exceptions and waivers went into effect. The coverage of the telephone E/M codes was part of the waiver and didn't change the way you level an office/outpatient visit.
 
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I'm reaching out to clarify the upcoming changes to Telehealth services for Medicare patients. Based on my understanding, effective April 1, 2025, we will no longer be able to provide Telehealth services to Medicare patients in their homes via audio or video. Instead, these services will need to be provided exclusively in-office.

Is this information correct?

Thank you for your time and clarification.
 
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lmanser said:
I'm reaching out to clarify the upcoming changes to Telehealth services for Medicare patients. Based on my understanding, effective April 1, 2025, we will no longer be able to provide Telehealth services to Medicare patients in their homes via audio or video. Instead, these services will need to be provided exclusively in-office.

Is this information correct?

Thank you for your time and clarification.
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There are some behavioral health telehealth that are allowed to continue, but since I never code BH, I do not recall the exact situations/scenarios/codes, but are aware they exist.
For everyone else, it is possible that Congress will pass legislation that will allow telehealth to continue past 04/01/2025. No one really knows at this point. If Congress does NOT take action, then most telehealth will not be covered after 04/01/2025 and will revert to pre-pandemic guidelines.
You may still provide the services, but they won't be covered (like a preventive visit 9938x-9939x).
 
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lmanser said:
I'm reaching out to clarify the upcoming changes to Telehealth services for Medicare patients. Based on my understanding, effective April 1, 2025, we will no longer be able to provide Telehealth services to Medicare patients in their homes via audio or video. Instead, these services will need to be provided exclusively in-office.

Is this information correct?

Thank you for your time and clarification.
Click to expand...
Hi there, apparently Congress included an extension of the current waivers until Sept 30
 
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