Wiki Telehealth Physical Exam

[KaylaRieken]

According to CMS guidelines for teleheath, they have said that your E/M level can be based on MDM or time. Is this for commerical payers too? So if a physical exam is not done for a new patient, can a 99203/99204 still be given if the MDM or time is there?

 

[shanamarie]

According to CMS guidelines for teleheath, they have said that your E/M level can be based on MDM or time. Is this for commerical payers too? So if a physical exam is not done for a new patient, can a 99203/99204 still be given if the MDM or time is there?

I have been searching for this also and can’t find a definitive answer. When checking with payors they were not clear in the answers they gave, and couldn’t provide a policy that stated this. We have continued to follow CPT guidelines.

Interested to see what others say, and if they were able to get a policy or something in writing.

 

[csperoni]

I have not seen anything from commercial carriers regarding this. I work at a large health system that follows Medicare guidelines for all carriers (based on the contract the health system has with the carriers).

I will note that if you are billing based on time, that is DEFINITELY allowed, as you could do this pre-covid as well. Time (documented, and that > 50% of total time is spent counseling coordination of care) is allowed for in person or telehealth. CMS has stated for telehealth only (not in person until 2021 E/M changes) you may bill based on MDM only.
I would feel comfortable using those guidelines for any carrier unless they have stated otherwise, which I have note seen anywhere.

 

[Mayzoo]

I gather though most commercial are all similar in the regulations, you wwould need to call to determine what each payer allows/disallows.