Telehealth Billing & Coding for Non-video Phone Calls

As CMS continues to update their policies on Telehealth during the COVID-19 pandemic and the Public Health Emergency, we are here to continue to keep you informed on these changes.

QUESTION: What are requirements to use regular office visit codes (i.e new patient codes, 99201-99205, and established patient codes 99212-99215) with Telehealth? Can regular office visit codes be used for just a phone call between the provider and the patient, that does not include video capability?

ANSWER: No. The provider must use telecommunication application, which mandates audio AND visual, under the Waiver 1135. They can use their smart phone or cell phone for the doctor-to-patient phone calls, and most cell phones have a video chat option. (i.e. Facetime, Skype, Google Duo, Facebook Video Chat).

I know this is causing the confusion. Also, some Medicare-aged patients are resisting and/or refusing the video chat option. This means that the visit is now, Telemedicine, not telehealth, and a phone call code 99441-99443 is the only option between your physician and/or QHP. The visit would need to be timed and still include consent, to report a phone call. CMS also added audio-only phone calls to the telehealth list for billing purposes with the 95-modifier. This modifier should be appended for any approved Telehealth service.

In the CMS chart below Medicare Telehealth visits it states telecommunication system (which mandates audio/video both).

From CMS.gov

QUESTION: When billing office visit codes for Telehealth, and the 2-way interactive video communications has been met and documented, what is the POS (Place of Service)? We were told 02 for Telehealth in March, but that has changed?

ANSWER: Yes, in the 3/31/2020 CMS published update and again, in the 4/9, 5/31 and 6/2 FAQ Sheet, CMS updated their position on the 02 POS, because using POS 02 will reduce services to be paid at a facility rate by about 20%.

For continuity, the Waiver 1135, was updated to instruct providers to use “the POS that would have been used had the patient had a face-to-face visit”. So if the patient is at home, but the physician is providing a Telehealth visit from his/her office, the POS would be 11 on the office visit code (99201-99215). You also need to include a -95 modifier to identify the service as delivered via Telehealth.

QUESTION: If the patient was seen in the past 7 days in the office or for a telehealth visit, and now calls for a phone only consultation, can we still bill this as a Virtual Check in (G2012) or a phone call (99441-99443, when they have that 7-day global period?

ANSWER: No. Both the Virtual Check-in code G2012 and the telephonic visits, 99441-99443 and 98966-98968, CPT descriptor has similar rules regarding these codes, with the cumulative global 7-day period. So if the patient was seen 7 days prior for a related condition, it is an extension of that visit. As a reminder, the Virtual Check in code G2012 does not need a 95 modifier.

QUESTION: A patient was seen via audio-video telecommunication, and the video portion stopped connection after 5 minutes due to weather and we could not get it back up. We continued with the audio portion of the Telehealth visit. Can we code for an office visit in this case?

ANSWER: Since the main focus of the visit was done without video chat capabilities, as mandated by the  new waiver in Section 1135(b) of the Social Security Act explicitly allowing the HHS Secretary to authorize use of telephones that have audio and video capabilities for the furnishing of Medicare telehealth services during the COVID-19 PHE.

This visit would now revert to a Telephonic visit, again, codes, 99441-99443, and time would need to be documented to enable the provider to choose the correct code. These are time-based codes.

QUESTION: If our Audio only visit goes passed 30 minutes, what code do we use to reflect more time?

ANSWER: There is currently no code for an audio-only phone call that reflects more than 30 minutes. CMS has stated that the CPT code 99443 is for 21 minutes or more.

QUESTION: Can a New Patient be seen via audio only phone call and/or virtual Check-in?

ANSWER: During the PHE, CMS has waived the established only patient relationship for Telehealth Services. This is a temporary waiver.

When will the PHE (Public Health Emergency) Time period end? According to the IFR (Interim Final Rule) dated, 5/31/2020, the PHE was extended through July 26th, 2020, until further notice.

For continued updates on Telehealth, please order our Telehealth Webinar below. This OnDemand Webinar is updated every 48 hours, as CMS and Commercial Insurers add more updates and changes.

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Please join Terry Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM for an on-demand webinar on how to implement these changes and more.

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2 Comments

  1. Sree Mura Devi Jagannathan says:

    Is there a free CEU links you offer any for CIRCC certified users?

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