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Essential Telemedicine Billing and Coding Tips for Providers

May 8, 2019

Telemedicine-Billing-TipsAdvances in modern technology and consumer demand both contribute to the increasing popularity of telemedicine. It’s been transforming the healthcare landscape, making it possible for patients to receive treatment from home. Providers now have the ability to communicate with patients at any time and anywhere, keeping on top of their health status and offering essential interventions when needed. As it becomes clear that telemedicine can reduce readmissions and even reduce the cost of care for patients, more payers are reimbursing for this type of care. If your practice will be offering telemedicine services to your patients, here’s a look at some essential telemedicine billing and coding considerations to keep in mind for 2019. 

Common Telemedicine Codes 

To make sure you’re getting paid for your telemedicine services, it’s critical to understand your state’s policy on telemedicine, as well as your payer guidelines. Providers also need to be aware of the codes used for billing telemedicine. Just a few of the commonly used outpatient evaluation and management codes that you may use for billing telemedicine include: 

  • New patient visits – 99201 – 99205
  • Established patient visits – 99212 – 99215
  • Consultations – 99241 – 99245
  • Codes for behavioral change interventions – 99406-99408

Must Read: Telemedicine and Coronavirus: What Medical Practices Need to Know

Many different codes are used for Medicare Fee-for-Service Providers, including: 

  • Follow-up inpatient telehealth consultations provided to beneficiaries in SNFs or hospitals – HCPCS codes G0406 – G0408
  • Individual and group behavior and health assessment and intervention – CPT codes 96150 – 96154
  • Telehealth consultations initial inpatient or emergency department – HCPCS codes G0425 – G0427
  • Individual telemedicine psychotherapy – CPT codes 90836 – 90838 and 90832 – 90834
  • Telehealth pharmacologic management – HCPCS G0459

New 2019 CPT Codes for Telemedicine 

For 2019, there are even more opportunities for your practice to be paid for telemedicine services. The government has taken big steps to embrace telehealth this year, and there are three new CPT codes for 2019 provided for chronic care remote physiologic monitoring. With these codes, health providers have a chance to use the latest technology to connect with patients more efficiently at home, gathering data that’s useful for care coordination and management. These three new CPT codes for 2019 include: 

  • 99453 – This code is for the remote monitoring or physiologic parameters (such as pulse oximetry, blood pressure, weight, etc.) initial, setup and education of the patient on using equipment 
  • 99454 – Device or devices supply along with programmed alerts or daily recordings transmission, every 30 days 
  • 99457 – Remote physiologic monitoring treatment managed services, more than 20 minutes of physician, clinical staff, or another qualified health professional time in a month that requires interactive communication with a caregiver or patient during that month 

Also remember, for 2019 CMS will be reimbursing providers for: 

  • GVCI1 – Brief communication technology-based services, such as virtual check-ins 
  • GRAS1 – Remote evaluation of images and/or recorded video that have been submitted by a patient 

With the first code, you can now be reimbursed for simple text, email, or phone interactions with a patient on the status of their medical problems. With the second code, if your patient sends in an image or video, you’ll be paid for evaluated it to determine the condition, its severity, and the follow-up that’s required. 

Top Tips for Billing and Coding Telemedicine 

Billing and coding telemedicine can be a bit tricky, but the following tips can help you make sure you get the level of reimbursement you deserve for telehealth services. 

  • Tip #1 Document Time Spent – As with all types of coding, documentation is also essential. For telemedicine billing and coding, documenting the time spent for the encounter is critical. Keep in mind, for many codes, you can only count your face-to-face time spent with the caregiver or patient when determining the level of service that was provided. 
  • Tip #2 Know How to Bill the Video Component – It’s possible to add the video component for telemedicine encounters to standard CPT codes by simply adding the 95 modifier. 
  • Tip #3 Include Documentation on Peripherals Used – If peripherals are used for telehealth assessments, such as spirometers, glucose monitors, thermometers, blood pressure monitors, or oxygen saturation monitors, you’ll need to document their inclusion when coding. They’re required to support the need for the specific CPT code you use. 
  • Tip #4 Don’t Use the 95 Modifier for Asynchronous Services – While the 95 modifier is used when there’s a video component for telemedicine encounters, you shouldn’t use it for telemedicine encounters that are asynchronous, such as radiograph studies, ultrasound studies, emails, etc. 

Remote patient monitoring and the ability to access telehealth services have a positive impact on your patients. It can result in the ability to offer patients more individualized care and improve overall patient outcomes. Medicare continues to expand the telemedicine services they’ll pay for, and other payers are expanding the services they cover, as well. Working with an experienced medical billing and coding company can help your practice take advantage of the exciting new opportunities in telemedicine, ensuring you get paid as you work on enhancing your patient reach through telehealth. To learn more about M-Scribe can help you with your telemedicine billing and coding needs, contact us today at 770-666-0470 for more information.


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