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jhendrix08

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Hi everyone....hoping some of you can shed some light on our ability to bill for telephone calls for patient's that have concerning symptoms. I know they are encouraging not bringing sick patients into the office and I'm not sure how to go about billing. What is the criteria and which code would we use? I have read that Medicare is allowing it, does anyone know if other commercial payers are as well?

We are a primary care office in California. Thanks so much for any guidance. I've done some reading and still not quite sure how to go about this.
 
I recommend everyone do their own research on this topic and reach out to their local AAPC chapter president but here is what I've been able to find out in my own research on this topic. This is simply a reference and in no way am I saying this is what you should do.

Medicare has their own HCPCS that they want you to use for telemedicine. Here is a link to the MLN article about it:

https://www.cms.gov/Outreach-and-Ed...NProducts/Downloads/TelehealthSrvcsfctsht.pdf

I'm in WA state so we're on the same coast as you Hendrix and I know a lot of our rules are similar but definitely reach out to your locate state licensing boards to double check the rules/regs about your doctor's licensure type and what they are able to bill in reference to telemedicine. That being said, commercial carriers such as BCBS, UHC, Aetna, etc will allow you to bill your standard E/M codes for telemedicine services. The way you'll note it is telemedicine and not an in office visit is through your use of modifiers and place of service codes on the CPT code your doc chooses to bill. Depending on the insurance payer, you'll need to use place of service code 11 to note office or place of service code 02 to note telehealth. Additionally, you'll need to select a -95 or -GT modifier (depending on the payer) to your E/M CPT.

Another big piece of this puzzle is to be sure you're using a HIPAA compliant telemedicine service. Facetime and Skype are not allowed so contact your medical records software to see if this a feature you can turn on or research options with outside companies.

Wishing all my billers and coders luck as we all move forward with helping our docs during these changing times.
 
Can you cold call with the telehealth? The other virtual visits etc have to be patient initiated. Using Telehealth and billing 99201-99215 can we reach out first? Thanks.
 
Mbielser311 said:
I recommend everyone do their own research on this topic and reach out to their local AAPC chapter president but here is what I've been able to find out in my own research on this topic. This is simply a reference and in no way am I saying this is what you should do.

Medicare has their own HCPCS that they want you to use for telemedicine. Here is a link to the MLN article about it:

https://www.cms.gov/Outreach-and-Ed...NProducts/Downloads/TelehealthSrvcsfctsht.pdf

I'm in WA state so we're on the same coast as you Hendrix and I know a lot of our rules are similar but definitely reach out to your locate state licensing boards to double check the rules/regs about your doctor's licensure type and what they are able to bill in reference to telemedicine. That being said, commercial carriers such as BCBS, UHC, Aetna, etc will allow you to bill your standard E/M codes for telemedicine services. The way you'll note it is telemedicine and not an in office visit is through your use of modifiers and place of service codes on the CPT code your doc chooses to bill. Depending on the insurance payer, you'll need to use place of service code 11 to note office or place of service code 02 to note telehealth. Additionally, you'll need to select a -95 or -GT modifier (depending on the payer) to your E/M CPT.

Another big piece of this puzzle is to be sure you're using a HIPAA compliant telemedicine service. Facetime and Skype are not allowed so contact your medical records software to see if this a feature you can turn on or research options with outside companies.

Wishing all my billers and coders luck as we all move forward with helping our docs during these changing times.
Click to expand...


Just FYI, HHS released a notice stating you can use facetime and skype during this time.
 

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Hi everyone ,
Just wanted to add my own piece of information as I'm so confused with all this!.I contacted medicare twice regarding CPT codes G2012 and 99421-99423 as they just released a fact sheet Dated March 17,2020 by CMS per both representatives i called stated that we could bill with CPT code G2012 for TELEPHONE services i specifically advice them that i was GI biller and wanted to confirmed the correct codes, first rep stated that i would fall under codes 99421-99423 based on her interpretation of the fact sheet that was just published as we are providing telephone services vs face to face services again she stated that it would fall under 99421-23's codes.She didnt sounded to assure.So then i called again and next rep stated that we could bill for both??? i advice her that we are providing telephone services so she said you can bill G2012.
BTW i'm in CA so you can imagine how my brain is right now!!!. If you guys can give an input regarding my feedbackor i'm looking at the correct codes to bill for Telehealth services? Now physicians want to bill for a regular e/m visits ? Note prior to this i did contact medicare and some of our privates regarding reimbursement and per mcare they don't pay for cpt codes 99421 but they do pay for G2012 private ins stated the same guidelines.
Any feedback will be greatly appreciated.

Thank you .
 
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