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Wiki New Telehealth CPT Code Questions

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nomie7

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Estacada, OR
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I have two questions for these codes:
1) Given the code descriptions themselves, would we need to use modifiers such as 95 or 93 on these CPT codes?
2) Would these codes be billable for telehealth performed with a patient in a hospital setting?
 
This guidance is only valid through March 31st, 2025. Congress may extend it once again when they meet again on March to avoid the gov't shutdown - these rulings are tied to that whole circus. :)

1) If you are using the new codes for those carriers that accept them, the modifiers would be not needed - but insurances sometimes make their own rules so you may need to watch for denials. Per the final rule, MC wants the usual E&M visit codes + 93/95 modifier. We are following that for MC and all carriers we know follow MC rules, all others will be billed with the new codes.

2) The new codes are only for office/outpatient. For inpatient telehealth, follow the same rules you followed on 12/31/24. The Final Rule, page 242, has this nice crosswalk:

1736285083176.png
 
Jumping off your question here do these new codes apply to out patient BH and Nutrition codes? Or do they continue to use the 95?
Thanks!
 
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