Telehealth during emergency periods

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
 
Just a FYI. Medicare is having a Webinar on March 25th on the NGS Medicare site in regards to the Telehealth. You have to register.
 
Our office billed G2012 with POS 02 and Medicare denied the claim stating "This service is not a covered Telehealth service". Has anyone else had this issue? If so any recommendations on corrections?
 
Our office billed G2012 with POS 02 and Medicare denied the claim stating "This service is not a covered Telehealth service". Has anyone else had this issue? If so any recommendations on corrections?
My understanding is POS 02 is ONLY for telehealth services. G2012 is a TELEPHONE (or virtual checkin) service, NOT telehealth. Telehealth is for interactive audio and video and billed E/M codes. I believe G2012 is POS 11, just like 99441-99443.

UPDATE ON 04/02/2020 TO ORIGINAL POST, AS GUIDANCE FROM CMS HAS CHANGED
As of 03/31/2020, CMS states for telehealth, "report the POS code that would have been reported had the service been furnished in person." with modifier -95 to designate it was telehealth. This way, you will get full reimbursement for nonfacility location, instead of reduced facility rate with POS 02.
Medicare will also now reimburse 99441-99443.

Guidance about POS/modifiers page 14-15. Guidance about 99441-99443 starts at bottom of 126.
 

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Radiation Oncology here. We see a lot of patients in followup after treatment is completed. Most medicare, some commercial. I need clarification. Since most of our patients are elderly and do not have access to Facetime, Zoom etc our providers are calling them for follow up appts intead of face to face in office visits. I need clarification on billing. My head is literally swimming. Normally we would bill 99212-99215 for a follow up office visit. Now that they are using ONLY telephone calls for these visits should we be using 99441-99443 OR G2012? Please also clarify the POS and Modifier I should be using for these codes. Last, if I am using the 99441-99443 where can I find the reimbursement rates as the fee schedule says these are not payable charges.
 
Radiation Oncology here. We see a lot of patients in followup after treatment is completed. Most medicare, some commercial. I need clarification. Since most of our patients are elderly and do not have access to Facetime, Zoom etc our providers are calling them for follow up appts intead of face to face in office visits. I need clarification on billing. My head is literally swimming. Normally we would bill 99212-99215 for a follow up office visit. Now that they are using ONLY telephone calls for these visits should we be using 99441-99443 OR G2012? Please also clarify the POS and Modifier I should be using for these codes. Last, if I am using the 99441-99443 where can I find the reimbursement rates as the fee schedule says these are not payable charges.

Use your regular office visit codes, changes the place of service to 02, and you may need a GT modifier. The new, temporary measures put into place do not require a secure program, but allows Skype, Facetime, etc., and also allows patients to stay at their home and not have to travel to an office to use telehealth. At this time, while some commercial payers are sending out notices that the video portion is not required, Medicare has not done so. However, HHS has announced a policy of enforcement discretion for services provided in good faith (to protect your patients from the virus while taking care of their healthcare needs). They specifically stated they will not enforce the requirement that the physician have an established relationship with the patient, as is normally required for telehealth. Take the "enforcement discretion" portion how you will.

The codes you reference above are for when a patient has a problem between appointments.

If your Medicare patients cannot do any kind of video, you would use G2012. You use this service to determine if you really need to see the patient in the office. Reimbursement is around $14-$15.
 
Does Medicare need the 95 Modifier billed with the office visit or is that only for commercial payers? if only commercial payers, what ones.
 
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.
I'm in Pediatrics as well. We are billing the 99213-99215 codes with modifier 95 (depending on ins) and POS 02 instead of the 99421-99423 codes. When researching specific policies with insurance, it appears the 99421-99423 codes are for Telehealth visits that are performed via a EMR portal or secure email. Since we are not currently doing Telehealth visits through our EMR, we are using codes 99213-99215. Hope this helps!
 
Question: For POS 2
If you are billing 99211-99215 for face to face video/audio telehealth... What are you putting in box 32 of your 1500 ? Are you using the office location where the provider is located ?
 
I'm in Pediatrics as well. We are billing the 99213-99215 codes with modifier 95 (depending on ins) and POS 02 instead of the 99421-99423 codes. When researching specific policies with insurance, it appears the 99421-99423 codes are for Telehealth visits that are performed via a EMR portal or secure email. Since we are not currently doing Telehealth visits through our EMR, we are using codes 99213-99215. Hope this helps!
What are you putting in Box 32 on your claim Form (relating to using POS 2) Are you using the Location your Provider is in doing the calls while using codes 99212-99215 ?
 
So what modifier is used GT or GQ I found something that stated GT is only used on institutional claims billed by CAH Medhod II providers? So what does that mean?

4448
 
I have providers in Pediatrics (WA) who want to provide Well Exams via telemedicine. A billing consultant in our group gave the following advice and I'm hoping to get some thoughts on this-
Yes – Well Child Checks are covered under TeleHealth –
Per Washington State law, managed health care systems (RCW 48.43.735) and private payers (RCW 74.09.325) must reimburse providers for health care services provided to a covered person through telemedicine if:
  • the health service is a covered service when provided by the provider;
  • the health service is medically necessary;
  • the health service is an essential health benefit under section 1302(b) of the ACA; and
  • the health care service is determined to be safely and effectively provided through telemedicine according to generally accepted health are practices and standards, and the technology meets standards required by state and federal laws. Per section 1302(b) of the ACA, essential health benefits are:
  • Ambulatory patient services.
  • Emergency services.
  • Hospitalization.
  • Maternity and newborn care.
  • Mental health and substance use disorder services, including behavioral health treatment.
  • Prescription drugs.
  • Rehabilitative and habilitative services and devices.
  • Laboratory services.
  • Preventive and wellness services and chronic disease management.
  • Pediatric services, including oral and vision care.
 
Pcp here. Are commercial insurances following Medicare telemed guidelines? Avmed and Aetna are only allowing 99441-99443- telephone evaluations and 99421-99423 Online digital evaluations. What about Sunshine and Molina? please share your thoughts
 
Does anyone have any experience with billing telehealth for a teaching clinic facility where residents are working under attending MDs. How are you all billing them? Using GE or GC modifiers?
I have the actual guidelines for billing from CMS but I cannot find anything about this situation.
Thank you
 
Does anyone have any experience with billing telehealth for a teaching clinic facility where residents are working under attending MDs. How are you all billing them? Using GE or GC modifiers?
I have the actual guidelines for billing from CMS but I cannot find anything about this situation.
Thank you
During the NGS Medicare telehealth webinar yesterday, the question was asked regarding teaching physician rules. The answer is that as of right now, the telehealth rules regarding teaching physicians has not been changed or modified.
https://www.cms.gov/Outreach-and-Ed...s/Downloads/Telehealth-Services-Text-Only.pdf specifies that 99231-99233 for inpatient subsequent visits may be billed telehealth only once every three days. I am interpreting this as provided the teaching physician references the resident note, making changes/updates, etc, and also "sees" the patient via interactive audio and video platform, the level is based on both the teaching physician and resident services and documentation, but only 1x every 3 days. If the teaching physician is ONLY seeing patient via telehealth, for the next 2 days, services are not billable.
 
I have providers in Pediatrics (WA) who want to provide Well Exams via telemedicine. A billing consultant in our group gave the following advice and I'm hoping to get some thoughts on this-
Yes – Well Child Checks are covered under TeleHealth –
Per Washington State law, managed health care systems (RCW 48.43.735) and private payers (RCW 74.09.325) must reimburse providers for health care services provided to a covered person through telemedicine if:
  • the health service is a covered service when provided by the provider;
  • the health service is medically necessary;
  • the health service is an essential health benefit under section 1302(b) of the ACA; and
  • the health care service is determined to be safely and effectively provided through telemedicine according to generally accepted health are practices and standards, and the technology meets standards required by state and federal laws. Per section 1302(b) of the ACA, essential health benefits are:
  • Ambulatory patient services.
  • Emergency services.
  • Hospitalization.
  • Maternity and newborn care.
  • Mental health and substance use disorder services, including behavioral health treatment.
  • Prescription drugs.
  • Rehabilitative and habilitative services and devices.
  • Laboratory services.
  • Preventive and wellness services and chronic disease management.
  • Pediatric services, including oral and vision care.
I am also looking for the answer to this - in all of the documentation I have received from our payors about what they'll cover for telemedicine, not one says that well visits are acceptable. I work in pediatrics, so we wouldn't be using the HCPCS wellness codes. Additionally, our CPT book doesn't have the star next to the preventive codes. So frustrating!
 
New CMS press release!

"Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. During the public health emergencies, individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services. Providers also can evaluate beneficiaries who have audio phones only. "

 
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?
You are correct. As long as audio and visual (both) are used then use the regular office codes (99212 thru 99214) and use place of service 02. I watched a webinar and they said the low level codes are preferred and a higher level warrants a face-to-face. The visit does not have to be COVID -19 related.
 
I am not finding this anywhere. I have been looking on CMS website and I can't find this new change.
As of 03/31/2020 interim final rule, CMS states for telehealth, "report the POS code that would have been reported had the service been furnished in person." with modifier -95 to designate it was telehealth. This way, you will get full reimbursement for nonfacility location, instead of reduced facility rate with POS 02.
Medicare will also now reimburse 99441-99443.

Guidance about POS/modifiers page 14-15. Guidance about 99441-99443 starts at bottom of 126.
This is CMS guidance only, and you should check with your commercial carriers about their rules.
Interim final rule: https://www.federalregister.gov/documents/2020/04/06/2020-06990/medicare-and-medicaid-programs-policy-and-regulatory-revisions-in-response-to-the-covid-19-public

It's also noted on the NGS Medicare website https://www.ngsmedicare.com/ngs/por...UqXX3mYkv7RG12A!!/dz/d5/L2dBISEvZ0FBIS9nQSEh/
 
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