Telehealth Billing

[chasebujak]

Hello!

I am looking for guidance and feed back on billing for a telehealth visit that is under 5 minutes. I have listened to the phone call and the provider addressed the cc, hpi, meds and hx and assessment and plan but the visit is just under 5 minutes. The 99441 code says its for 5-10 minutes only. What other code can I use?

 

[mitchellde]

if this was a phone call initiated by the patient then it is not telehealth, it is a phone call encounter and the only billable codes for phone calls is the 99441-99443. If the length of the call is less than 5 minutes then it is not a billable encounter and there is no other code you can use.

 

[chasebujak]

99441

Even if we have contracted rates with payers and affiliations we still are not able to bill for under 5 minutes? We only operate with MA Advantage plans, MCD, Commercial not straight Medicare or Medicaid.

 

[mitchellde]

the codes and instructions indicate the anything less than 5 minutes is not coded using the 99441 and there is no alternative code. you cannot apply a different definition or instruction than what is in the code book.

 

[dfronsoe]

I am just asking for clarification, all telehealth visits are time-based, not levels? We typically bill for 99213-99214; but, if we are doing visits via portal, spending 20-30 minutes each visit (at least 5-10 minutes in medical discussion), we would bill 99423 and HCPS G2012? Is this correct?

 

[KTOWNSEL]

I am seeing on the Medicare website that the allowable is ZERO. Anyone have any info on that?

 

[ksanthony]

99441 has a status code of N for Medicare, therefore it is a non-covered service. Medicare Link
Medicare does not pay separately for physician or nonphysician telephone conversations with patients (or their families), but that these conversations may be taken into account when the physician is determining which level of evaluation and management (E/M) code to assign on the next claim for a face-to-face E/M visit. Codes meeting this criteria are bundled under the Medicare physician fee schedule. However, because the code descriptors for CPT codes 98966 through 98969 and 99441 through 99444 state “not originating from a related E/M service nor leading to an E/M service” we assigned a status indicator of “N” (Non-covered service) to these services. Because these are noncovered services under the Medicare physician fee schedule, the physician or nonphysician practitioner may bill the beneficiary directly for these services as defined in the CPT, at his/her established rate. Although an ABN is not required, we would strongly encourage providers to issue the voluntary “Notice of Exclusion from Medicare Benefits (NEMB” so patients can make informed decisions in these situations. Information about these notices can be found at: http://www.cms.hhs.gov/BNI/11_FFSNEMBGeneral.asp#TopOfPage. We would like to remind providers that to be billable to the beneficiary the service must not be related to an E/M visit and must meet every part of the CPT definition and must be documented in the patient’s record. (Note: Contractor discretion should be used to determine if service is related to an E/M visit.)