Wiki Telehealth during emergency periods

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According to CMS we can use the desginated E/M codes with POS 02 and modifiers 95, GT, or QT where applicable. Telehealth pdf and you can also visit https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes Hope this helps!

NF2712

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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 the current bill that was passed waives the originating site, however, I am directly reading from that act, Telehealth Services During Certain Emergency Periods, and it states

“(A) the requirements of paragraph (4)(C) of such section, except that a facility fee under paragraph (2)(B)(i) of such section may only be paid to an originating site that is a site described in any of subclauses (I) through (IX) of paragraph (4)(C)(ii) of such section"

From what I am interpreting, in order to bill for telehealth, there is still a requirement for patients to be in a designated originating site. I am just wondering if others are interpreting this the same way I am. Thanks :)
 

jhendrix08

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I have asked this same question and haven't yet gotten any responses. From what I have read, Medicare has lifted the originating site requirement to allow for more providers to use telehealth services to treat symptomatic patients. However, I'm not sure that skype would meet the privacy requirements for audio video. If you find more info on this I would be grateful if you would share....I will keep reading and will report back if I find anything useful!
 

jhendrix08

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President Trump just announced that Skype and FaceTime will be allowed for Telehealth services. This is huge! The press conference is being held now so I'm sure we will be able to find this in writing today.
 

kimlawson

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Telehealth codes: 99421-99423, 99446-99452, G2010, G2012, G2061-G2063. They are stating we can bill 99201-22215 with POS 2, modifier 95. QT and GT are also possible modifiers. Also, larger healthcare plans are now reimbursing the telehealth codes. ie. BCBS, Aetna, Cigna, United Healthcare. It's policy specific.
What is modifier 95? CMS states -GT discontinued in 2017, I believe. But I've seen that some on here are still using it and getting paid.
 

erinreid1234

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We are as well. Telehealth. I work for an Orthopedic company. My manager has notified us as of today that all Insurances will cover Telehealth CPT codes. We are thinking of doing Skype with our patients. My manager has also said today that an option is for them to be at home during this time and we can do the Telehealth and Skype them at home.
 

erinreid1234

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Absolutely, Thank you so much! I will keep you both posted in this thread! I'll let you know when we start using the Telehealth. I'll pass that along to my manager about Skype.
 
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Greenville, SC
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I work for a Nephrology practice and our providers are talking about closing for precautionary measures. I have a couple of physicians who are telling me they have heard they can bill regular face to face E&M codes (99213, 99214) for telehealth and we would just change the POS code to 2 instead of 11. Do any of you have information on this as far as specialist billing these codes for telehealth follow up visits not relating to diagnosing the COVID-19?
 

erinreid1234

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I work for a Nephrology practice and our providers are talking about closing for precautionary measures. I have a couple of physicians who are telling me they have heard they can bill regular face to face E&M codes (99213, 99214) for telehealth and we would just change the POS code to 2 instead of 11. Do any of you have information on this as far as specialist billing these codes for telehealth follow up visits not relating to diagnosing the COVID-19?
That's a great question! We may start using the Telehealth next week, but I'll let you know in this thread if we use those codes (99213, 99214) or not!
 
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Thank you, everyone! We are a Pain Management practice looking to utilize Telehealth services during this challenging time. Any information you can provide is appreciated!
 

jhendrix08

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Does anyone have the correct CPT billing codes for Telehealth? I have heard (as stated above) that we can use 99213, 99214 with POS 2 and I have also heard that you cannot use these face to face codes.

Also, do any of you know if commercial payers are allowing reimbursement for Telehealth? It sounds like it's just Medicare for now (?)
 

kathleeng

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Telehealth codes: 99421-99423, 99446-99452, G2010, G2012, G2061-G2063. They are stating we can bill 99201-22215 with POS 2, modifier 95. QT and GT are also possible modifiers. Also, larger healthcare plans are now reimbursing the telehealth codes. ie. BCBS, Aetna, Cigna, United Healthcare. It's policy specific.
 

kguzikowski

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I also work for a Nephrology Practice in Wisconsin. So in reference to Telehealth services as it is currently set up . Service must be a face to face occurrence utilizing some type of internet video conference platform is that correct? Services provided by telephone only are not covered from my understanding, unless that has changed temporarily due to COVID-19? Received Information from our provider Representative that Unitedhealth is allowing telephone calls
temporarily until April 30th between physician and patient. Has anyone else received that communication?
 

whughes9805

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I am with pain management as well. My doctor is insistent that he cannot do telehealth for the opioid prescriptions. Have any other pain specialists found anything out on this?
 
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I am with pain management as well. My doctor is insistent that he cannot do telehealth for the opioid prescriptions. Have any other pain specialists found anything out on this?
We refuse to do telehealth for pain management. Technically, right now you can do anything specialty via telehealth. Whether that is a smart idea or not, is another question.
 

kimlawson

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I have asked this same question and haven't yet gotten any responses. From what I have read, Medicare has lifted the originating site requirement to allow for more providers to use telehealth services to treat symptomatic patients. However, I'm not sure that skype would meet the privacy requirements for audio video. If you find more info on this I would be grateful if you would share....I will keep reading and will report back if I find anything useful!
 

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kimlawson

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I am with pain management as well. My doctor is insistent that he cannot do telehealth for the opioid prescriptions. Have any other pain specialists found anything out on this?
Same here. We believe it is state regulated. We're in Texas so still looking here as things are changing quickly...appreciate any findings.
 

kimlawson

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Does anyone have the correct CPT billing codes for Telehealth? I have heard (as stated above) that we can use 99213, 99214 with POS 2 and I have also heard that you cannot use these face to face codes.

Also, do any of you know if commercial payers are allowing reimbursement for Telehealth? It sounds like it's just Medicare for now (?)
I have been wondering the same thing but 99201-99215 ARE listed on CMS as Telehealth codes (see attached). Aetna has put out a statement that they will allow.
 

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Attleboro, Massachusetts
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Pediatrics here. We don't bill any medicare.... I'm TRYING to figure out under what circumstances we can use the 99213-99215 with modifier 95 and POS 02 versus using the telehealth 99421-9432 codes. The reimbursement rate for the standard E/M codes are much higher than the telehealth codes and I cannot figure out when/how to use each scenario. We are going to be doing visits via just audio as well as audio/video. If anyone has any information on when it's appropriate to use these sets of codes it would be greatly appreciated because it seems to me we can do either way?? HELP.
 
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I work for an Otolaryngology practice and physicians want to start seeing patients via telehealth. Has anyone in this specialty started using telehealth and if so, what codes are you billing and what modifiers are you using? Any help would be greatly appreciated.
 

kathleeng

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Fresno, CA
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Pediatrics here. We don't bill any medicare.... I'm TRYING to figure out under what circumstances we can use the 99213-99215 with modifier 95 and POS 02 versus using the telehealth 99421-9432 codes. The reimbursement rate for the standard E/M codes is much higher than the telehealth codes and I cannot figure out when/how to use each scenario. We are going to be doing visits via just audio as well as audio/video. If anyone has any information on when it's appropriate to use these sets of codes it would be greatly appreciated because it seems to me we can do either way?? HELP.
I am also, trying to figure out the same. I don't know if maybe it's when the visit doesn't fall into the requirements of the telehealth codes, so we are to bill the 99212-99215... I'm trying to navigate the same. Our doctors are starting this now so I'm researching like crazy. Anyone have information? Much appreciated!!
 
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I am also, trying to figure out the same. I don't know if maybe it's when the visit doesn't fall into the requirements of the telehealth codes, so we are to bill the 99212-99215... I'm trying to navigate the same. Our doctors are starting this now so I'm researching like crazy. Anyone have information? Much appreciated!!
We are also starting this in our peds office in Colorado. I cannot find any clear information.
 

kguzikowski

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Muskego, Wisconsin
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Im looking for essentially the same information . Our physicians are concerned about those patients who no access to audio/video communications. Meaning the contact would be via phone call only utilizing codes 99441, 99442, 99443 for MDs, and 98966, 98967 and 98968, can we bill those codes and use POS 11 ? Also I would imagine the reimbursement is much lower. Looking at the CPT guidelines seems a little unclear, can we just bill these codes as a documented E/M services via a phone call with no additional requirement attached. We have an elderly population many do not have access to any other vehicle than their phone, and ay not have the knowledge or capability to use face time, or skype.? ANy input or guidance is helpful.
 

Metroderm

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Announcement said that it'll be paid on Facility rate, but I can't find the rate. Does any one has NY Queens x Bronx fee schedule?
 
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I dont know if anyone has answered this but Trump said they will be temporarily relaxing certain HIPAA requirements so that doctors can provide telehealth with their own phones using Skype, FaceTime and the like.
 

harpermmb

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We are primary care and our EHR has video capabilities. We bill 99211-99214 with POS 2 and modifier 95. Lately we are having issues with BCBS and Aetna paying these. Seems to be based on the patients plan. If the patient has access to online services with the insurance plan then it is not getting covered when we bill it.
 

Patricia P Williams

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Ruckersville, VA
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We are primary care and our EHR has video capabilities. We bill 99211-99214 with POS 2 and modifier 95. Lately we are having issues with BCBS and Aetna paying these. Seems to be based on the patients plan. If the patient has access to online services with the insurance plan then it is not getting covered when we bill it.
Is Medicare paying the 99211-99214 with POS 2, mod 95 or are you billing the 99421, 99422 or 99423 with POS 2?
 

Billing2

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Hi, you would use OV Cpt code - with 95 mod & POS 02; only good for established patient; Provider need to notate that this is Telehealth visit; Provider need to notate Time spent; you have to make sure you are in-network with your members ins; can also be coded how complex the visit was. It doesn't have to be a time based coding but Time spent is one of the requirement to be charted.
Hope this helps!
(Also works for Peds)
 

Billing2

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Pediatrics here. We don't bill any medicare.... I'm TRYING to figure out under what circumstances we can use the 99213-99215 with modifier 95 and POS 02 versus using the telehealth 99421-9432 codes. The reimbursement rate for the standard E/M codes are much higher than the telehealth codes and I cannot figure out when/how to use each scenario. We are going to be doing visits via just audio as well as audio/video. If anyone has any information on when it's appropriate to use these sets of codes it would be greatly appreciated because it seems to me we can do either way?? HELP.
Hi, You would use standard OV codes 99213-15 with 95 mod & POS 02; Established patient only; Time spent must be charted and state that this is Telehealth visit; Can also be coded by Complexity not necessarily time; you must be in-network with patient ins; you need Hipaa compliance authorization (although Trump announced that due to Public health emergency, ins have a relaxing Hipaa requirement)

Hope this helps! 99421 codes are Online digital codes ex: EHR portal
 
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Can anyone know about billing in domiciliary or rest home during this emergency.

i have checked many sites and medicare guideline but no one discussed about domiciliary facility.
which CPT we will use for medicare and which POS we will use for reimbursement.

Help!
 

Jennikate

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Webster, Florida
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It is in one of the many updates they will not go after practices using skype or facebook messager during the crisis . For phone calls no visual look into g0071 as well as others that have been mentioned. Good luck to all of us. We have the added wrinkle of being Rual Health Clinic.. Can I go home now?
 
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Maple Valley, Washington
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Hi, You would use standard OV codes 99213-15 with 95 mod & POS 02; Established patient only; Time spent must be charted and state that this is Telehealth visit; Can also be coded by Complexity not necessarily time; you must be in-network with patient ins; you need Hipaa compliance authorization (although Trump announced that due to Public health emergency, ins have a relaxing Hipaa requirement)

Hope this helps! 99421 codes are Online digital codes ex: EHR portal
Thank you for that response. I kept telling my supervisor that 99421-99423 codes were probably for secure email and patient portals.
 
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lcouto

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I am really confused now with the Telehealth codes and what to use. I work for a group of Cardiologist and they want to start doing telephone visits for our elderly patients during the COVID-19 outbreak.. Just unsure of what codes we would bill. We have no video capabilities. Could someone help clarify? Please
 

csperoni

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Selden
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From my understanding, 99212-99215 are used ONLY for telehealth which is interactive audio and video (note that they have temporarily lifted many requirements, and the interactive audio/video may be via Skype, FaceTime, etc.)
99421-99423 are for patient portal.
99441-99443 are for telephone.

EVERYONE WITH ADDITIONAL QUESTIONS SHOULD FIRST READ THIS ENTIRE THREAD. I'm seeing a lot of duplicate postings and questions
 

lcouto

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From my understanding, 99212-99215 are used ONLY for telehealth which is interactive audio and video (note that they have temporarily lifted many requirements, and the interactive audio/video may be via Skype, FaceTime, etc.)
99421-99423 are for patient portal.
99441-99443 are for telephone.

EVERYONE WITH ADDITIONAL QUESTIONS SHOULD FIRST READ THIS ENTIRE THREAD. I'm seeing a lot of duplicate postings and questions
Thank you for clarifying and for your time.. I appreciate it
 
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