Telemedicine. A relatively new phenomenon in healthcare with its own coding and billing rules. In this edition of “In the kNOW”, we will look at some of the CPT coding particulars surrounding telemedicine.
Telemedicine means using telecommunications systems (audio and visual) in order to diagnosis and/or treat a patient remotely.
Appendix P in the CPT Manual lists 79 codes that can be used to report telemedicine services when modifier 95 is added. These codes are identified in the CPT Manual code list with the symbol of a star (★) preceding the code. These codes reflect the following services:
Modifier 95 is used to identify a synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. Previously modifier GT was in use for telehealth billing but was discontinued at the beginning of 2018 because a new place of service code (02) indicates telehealth now. However, GT it is still needed for any distant site telehealth services performed under Critical Access Hospital (CAH) method II billing. There is also a GQ modifier to be used for asynchronous telecommunication systems visits but that applies only to services in Alaska and Hawaii.
Medicare requires that the communication take place from a qualifying originating site such as:
An eligible Medicare beneficiary must be at one of the originating site locations listed above when the telemedicine service takes place. These originating sites are required to be located in a rural Health Professional Shortage Area (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA). Some sites have been participating with the Department of Health and Human Services on a demonstration project and therefore, are considered originating sites despite their geographic location. Due to the complexity of determining the eligibility of an originating site, there is an on-line tool-the Medicare Telehealth Payment Eligibility Analyzer-to assist.
There are specific practitioners who are eligible to perform services and receive reimbursement for telemedicine services. They are:
These practitioners, located at the distant site, will use Place of Service code 02 for Telehealth. They then bill the appropriate CPT code or HCPCS Level II code with the appropriate modifier. Payment for the originating site is achieved by submitting HCPCS code Q3014.
Now you are in the kNOW!!
Appendix P in the CPT Manual lists 79 codes that can be used to report telemedicine services when modifier 95 is added. These codes are identified in the CPT Manual code list with the symbol of a star (★) preceding the code. These codes reflect the following services:
- Psychotherapy
- Psychoanalysis
- Pharmacological management with psychotherapy
- ESRD services
- Remote imaging for retinal disease
- Remote imaging for monitoring and management of active retinal disease
- External mobile cardiovascular telemetry
- Technical support for above
- External patient auto activated ECG
- Interrogation device evaluations-loop recorder
- Interrogation device evaluations-implantable cardiovascular monitor system
- Medical genetics and genetic counseling services
- Neurobehavioral status exam
- Health and Behavior Assessment/Intervention
- Medical Nutrition Therapy
- Education and Training for Patient Self-management
- E&M for new patients
- E&M for established patients
- Subsequent hospital care
- Office and inpatient consultations
- Subsequent nursing facility care
- Prolonged services
- Behavioral Change Interventions, Individual
- Transitional Care Management services
Modifier 95 is used to identify a synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. Previously modifier GT was in use for telehealth billing but was discontinued at the beginning of 2018 because a new place of service code (02) indicates telehealth now. However, GT it is still needed for any distant site telehealth services performed under Critical Access Hospital (CAH) method II billing. There is also a GQ modifier to be used for asynchronous telecommunication systems visits but that applies only to services in Alaska and Hawaii.
Medicare requires that the communication take place from a qualifying originating site such as:
- Hospital
- Physician or practitioner’s office
- Rural health clinic
- Critical access hospital (CAH)
- Skilled Nursing Facility
- Community Mental Health Center
- Hospital-based or Critical Access Hospital-based renal dialysis center
- Federally Qualified Health Center
An eligible Medicare beneficiary must be at one of the originating site locations listed above when the telemedicine service takes place. These originating sites are required to be located in a rural Health Professional Shortage Area (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA). Some sites have been participating with the Department of Health and Human Services on a demonstration project and therefore, are considered originating sites despite their geographic location. Due to the complexity of determining the eligibility of an originating site, there is an on-line tool-the Medicare Telehealth Payment Eligibility Analyzer-to assist.
There are specific practitioners who are eligible to perform services and receive reimbursement for telemedicine services. They are:
- Physicians
- Nurse practitioners
- Physician assistants
- Nurse-midwives
- Clinical nurse specialists
- Certified registered nurse anesthetists
- Clinical psychologists and clinical social workers
- Registered dietitians or nutritionists
These practitioners, located at the distant site, will use Place of Service code 02 for Telehealth. They then bill the appropriate CPT code or HCPCS Level II code with the appropriate modifier. Payment for the originating site is achieved by submitting HCPCS code Q3014.
Now you are in the kNOW!!
About the Author
Dianna Foley, RHIA, CHPS, CCS is
OHIMA's Coding Education Coordinator. Dianna has been an HIM
professional for 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.
