Question Article 28 Telehealth Billing

K22B

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Good Morning. I posted this question yesterday but in the wrong topic area. We are an Article 28 facility in NY and started to provide Telehealth and Telemedicine services. We are confused to which codes to use?? Are we to use reg. E/M codes with appropriate modifiers 95 and GT for the Telehealth services. Or do we bill 99441-99443 for Telemedicine and then 99421-99423 for Telehealth with appropriate modifiers. We do split billing in this facility ( Institutional and professional claims) and I have read different articles and guidelines that are conflicting. Any guidance would be appreciated.

Thank you
Karen
 

arosborne

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Lakeland, FL
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Hi Karen,
I believe a great number of us have these questions right now!
It is my understanding that if your provider is doing an audio & video (Skype/Zoom/Facetime, etc) type visit with the patient, they use their normal E&M code, modifier 95 for commercial payers or modifier GT for Medicare patients, and every insurance uses place of service code 02. It is also my understanding that codes 99441-99443 are for non face-to-face visits which are phone calls (no video). The CPT 2020 book also specifies if a telephone call visit ends with the decision to see the patient within 24 hours, you can't bill the 99441-99443 separately from the visit to which the patient is seen within that 24 hour period. Also, if the telephone call visit refers to an E&M service performed within the previous 7 days or within a postoperative period after a procedure, then the telephone visit is considered part of that prior procedure/E&M. The modifier 95/GT is for synchronized telemedicine service rendered via a real-time interactive audio and video telecommunications system which is why it only applies to the telemedicine visit and not the telephone visit.
Stay well and safe! :)
 

K22B

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Hi Karen,
I believe a great number of us have these questions right now!
It is my understanding that if your provider is doing an audio & video (Skype/Zoom/Facetime, etc) type visit with the patient, they use their normal E&M code, modifier 95 for commercial payers or modifier GT for Medicare patients, and every insurance uses place of service code 02. It is also my understanding that codes 99441-99443 are for non face-to-face visits which are phone calls (no video). The CPT 2020 book also specifies if a telephone call visit ends with the decision to see the patient within 24 hours, you can't bill the 99441-99443 separately from the visit to which the patient is seen within that 24 hour period. Also, if the telephone call visit refers to an E&M service performed within the previous 7 days or within a postoperative period after a procedure, then the telephone visit is considered part of that prior procedure/E&M. The modifier 95/GT is for synchronized telemedicine service rendered via a real-time interactive audio and video telecommunications system which is why it only applies to the telemedicine visit and not the telephone visit.
Stay well and safe! :)
 

K22B

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Thank you for your response. I also stated we are an Article 28 site. Our provider is providing at this location. For our Institutional claims should we billl Q3014. If I am reading Medicaid guidelines correct it seems it is the only way through APG’s to recoup administrative expenses with the telemedicine encounter. Any guidance on that??
Thank you
 
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