1. Y

    Question Heres a fun one -- rn in home & dr via telehealth

    Most important, we are a wound clinic not a home health agency. Traditionally, when we see patients at home, the billing provider and a clinician go to the home together. However, management now wants just an RN to go to the home and the billing provider be "present" via video telehealth...
  2. C

    Wiki Pennsylvania Medicaid Audio-Only Telehealth Denials

    I'm in need of some help here with audio-only telehealth claims for Medicare patients with secondary Pennsylvania Medicaid plans. When billing Medicare (as primary), we use codes 99441-99443. However, we run into a problem with the claim going to secondary. PA Medicaid only accepts G2012 for...
  3. A

    Wiki CMS Telehealth changes 2024 ABA Therapy

    Hello, I am working for an ABA Therapy company and stumbled across the MLN for telehealth coding. According to this document and the list of telehealth-approved codes, ABA therapy can not be performed with audio only. Does anyone have any additional information regarding the new telehealth...
  4. P

    Wiki Office Visits via video

    First question, is an office appointment that is conducted via video still considered a face-to-face appointment? Second question, the patient is in the office, but the physician is in another state conducting the appointment via video. I believe this would still be billed with modifier 95, but...
  5. C

    Wiki MA Performing Physical Exam via Telehealth

    I work at a third party billing company as a medical coder and biller. It has come to my attention that one of our clients has been "performing" physical exams in a way I've never heard of. My manager says this is completely okay to do, but I'm just wanting to make sure. So... The provider in...
  6. K

    Wiki Patient on phone, representative in office

    Hey all! I am stumped and could use some help. We had a provider scheduled to see a patient. The patient's wife was at the appointment in person, but the patient was on the phone. I am totally lost on how to code this. Is it a telehealth since the patient was on the phone? Is it considered in...
  7. A


    Could someone assist me with the new policy for billing Audio-only visits (99441 - 99443) in an Independent clinic after the Public Health Emergency (PHE)? I've encountered denials from UHC and Medicaid-Mississippi stating that these services are no longer covered. I've reviewed their state...
  8. M

    Wiki incident-to drug screens question

    One of our providers only works remotely and sees all his patients through telehealth. He sees patients who are going through treatment for opioid addiction. This requires the patients to come into the clinic and have drug screens performed by the medical assistant. Since this provider is never...
  9. B

    Wiki Psychotherapy via Telehealth While on Vacation

    Hi there, and thank you all in advance! I have a behavioral health provider (LPC) who has an opportunity to work remotely in another country for a few months and was hoping to continue to see their patients via telehealth while away. The provider is licensed in the state all of their patients...
  10. S

    Wiki CPT 59430 Postpartum Only - Telehealth

    Good morning to all you global billing masters! It's hard to believe we've come this far with telehealth and now the question arises as to whether it's appropriate or not to use telehealth POS when needing to bill with CPT 59430 postpartum care only. Have any of you had experience with this...
  11. C

    Wiki FQ & 93 Audio Only Modifiers

    Has anyone begun using audio only telehealth modifiers FQ & 93? It seems that 93 is for Medicare and FQ is for Commercial & Medicaid payers?
  12. lgardner

    Wiki Audio only telehealth visit - seen within 7 days prior

    hello fellow coders- I have a question, which I am not able to find the answer to (at least not as quickly as I'd like). for audio only telephone visits (99441-99443): "Telephone or audio-only evaluation and management services for new and established patients, cannot originate from a related...
  13. S

    Wiki Telehealth and Risk Adjustment Validation

    Debating the interpretation of the CMS telehealth video requirement to validate HCC conditions. This (quote below), to my knowledge, has been interpreted as the video needing to be enabled for the entirety of the visit. Thoughts? Do we have guidance or update anywhere that delineates between...
  14. J

    Wiki Telehealth Group Therapy

    Hello- I work for a Medicaid only outpatient school based behavioral health agency in WA state. With summer approaching, we do a lot of group therapy with students which we have made in person only because out interpretation is that it was not billable via telehealth. There is some debate...
  15. C

    Wiki Telehealth

    Hi... We're looking for help for a United Health Commercial member. Our patient had a telephone only visit with our physician in January 2022. We used CPT code G2012 only, as we used all of 2021. Our claim has been denied multiple times, and United is telling us that we need to use a primary...
  16. B

    Wiki Telehealth E/M Codes + Modifier Requirements

    I am looking for coding scenarios/examples on which E/M codes to assign for telehealth visits at a provider based facility. (We are a CAH with a family medicine clinic, majority of telehealth is the family health clinic) Based on what I'm reading in my CPT book, we should be using the 9944x...
  17. A

    Wiki Telehealth Guidelines for Physical Therapy during PHE

    Can anyone provide CMS's billing guidelines for telehealth rehabilitative services, including appropriate POS and modifiers? I am having trouble finding it.
  18. K

    Wiki Telehealth Ending

    UHC posted on their website the state of emergency that granted telehealth coverage is set to end on July 19th. I cant find anything from Medicare, and wondered if anyone else has heard this, or what actions will you take after July 19th?
  19. B

    Wiki Telemedicine in Hospital Setting

    Anyone performing telemedicine visits as the role of a hospitalist? I'm looking for very specific info....we would like to contract with a hospital and have them pay us a flat rate for our services (diabetes management). The issue is how does the hospital itself get reimbursed for the services...
  20. K

    Wiki Psychotherapy telehealth COVID Modifier for BCBS?

    Hi, I have someone that isn't get full coverage for telehealth psychotherapy unless it is COVID related. How would I submit a claim letting them know the visits are due to stress of COVID. Is there a modifier for that?

    Wiki Telehealth xrays

    Hi there, I work for an ortho clinic so we have our own xray equipment. We normally bill out xrays without a modifier for in-office visits, but with telehealth the patient came in a few days earlier for xrays. We are receiving denials for billing xrays with a TC mod when the pt physically comes...
  22. R

    Wiki Telehealth interrupted

    What would you code/bill (I'm with an FQHC in AR) a telehealth virtual visit where connection was lost and ended up just being a telephonic visit? Would it depend on the time of each? What about a modifier? (I'm thinking reduced service maybe?) Any help would be appreciated.
  23. KStaten

    Wiki Coding / Billing Audio-Only Telehealth Visits

    Hello Everyone! :) Here's my silly question for the day. (Brace yourselves, as I am sure more are to come. ;) ) As I have interpreted from articles, the accepted Telehealth services have been expanded to include audio-only telephone calls, as well. (Yay!) Now this is the part where I am...
  24. L

    Wiki Telehealth Consent Duration -Missouri

    Does anyone know the Missouri requirements regarding consent for telehealth services? Does this need to be obtained/documented prior to each telehealth visit or is it good for a period of time? Thank you!
  25. T

    Wiki Physical exam in a Telehealth visit

    Does anyone have information about documenting physical exam for established patient telehealth visits billable using 99201-99215? It would seem a limited exam could be documented based on physician observations during the call. I know it isn't technically required (2/3 elements and all that)...
  26. K

    Wiki Telehealth Scenario - Video to phone

    Hello, Do you know how our providers would code if they are attempting a virtual video visit, but technology fails (video freezing, poor connection, etc.) and the provider has to finish the visit via telephone? I have communicated that the provider would have to use the phone codes at that...
  27. K

    Wiki Telehealth Scenario

    Hello, Do you know how our providers would code if they are attempting a virtual video visit, but technology fails (video freezing, poor connection, etc.) and the provider has to finish the visit via telephone? I have communicated that the provider would have to use the phone codes at...

    Wiki New Patients Telehealth

    Has anyone seen anything about the waiver allowing providers to see new patients via Telehealth?
  29. N

    Wiki Telehealth Billing

    I am wondering if anyone has any guidance or recommendation on billing virtual telecommunication visits? How to bill (codes, modifiers, ect...)? Payer reimbursement? Any information would help! Thanks in advance for any information!
  30. N

    Wiki Telecommunication Billing

    I am wondering if anyone has any guidance or recommendation on billing virtual telecommunication visits? How to bill (codes, modifiers, ect...)? Payer reimbursement? Any information would help! Thanks in advance for any information!
  31. B

    Wiki inpatient physician telehealth

    Hi! I need help with inpatient telehealth coding, billing, and set up. Please reach out to me directly at if you have knowledge! Looking into when the G-codes for inpt telehealth consults are appropriate. Thanks, Brooke
  32. B

    Wiki Inpatient Telehealth Consult vs admit?

    Hi, Our hospitalists are looking to provide inpatient telehealth. Medicare has waived the originating site requirements. It doesn't look like CPTS 99221-99223 are on the telehealth list. Would you bill G0425-G0427 instead? Who and when would these be appropriate? Thanks!!!
  33. N

    Wiki Telehealth during emergency periods

    I am working at a pain management clinic and the practice is currently looking into telehealth, using a face-to-face like Zoom, because of COVID. However, from what I am seeing, the only way we can bill for telehealth is if the originating site is not the patient's home. My manager insists that...
  34. B

    Wiki Telemedicine - mental health

    Hello everyone! I have a mental health provider (LCSW in an office setting in the Chicago suburbs) who insists Medicare changed the rules and will now allow her to bill telemedicine because her friends in NYC are billing and getting paid. Does the rural area rule no longer apply? How about...
  35. C

    Wiki Carolyn Williams

    Please tell me what the CPT code is for when Triage is performed over the phone, meaning telephonically. Scenerio: worker gets injured, calls 800 number for a telemedicine company that performs triage and emergent care. Injured worker speaks to an ER doctor who tells them to apply hot pack...
  36. L

    Wiki inpatient telehealth question

    hello one of my outpatient MD has been approached to provide telehealth psy services for an inpatient unit. We utilize telehealth with outpatient but I am not familiar with doing inpatent. are any of y'all billing this service if so are you getting paid. thanks lisa