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Some patients may benefit from telehealth visits

Some patients may benefit from telehealth visits

We have had many inquiries from members, as a result of the proliferation of the Coronavirus COVID-19, asking how they can provide care to their patients remotely to avoid spread of infection.

Many payers, including Medicare, provide coverage for telehealth services. Telehealth is typically defined as real-time audio and visual communication with a patient, usually via a telehealth portal or platform. Unfortunately, Medicare limits telehealth benefits to patients residing in rural areas who must present at a health facility for the service. However, President Trump just signed emergency legislation that would allow CMS to temporarily waive these restrictions so patients could receive care at home. Under the new legislation, patients will be allowed to participate in a telehealth visit from their homes in both rural and urban areas. Telehealth visits must apply to established patients only (patients seen by the provider within the past three years). CMS recently issued frequently asked questions and answers (FAQs) for health care providers regarding Medicare payment for laboratory tests and other services related to the 2019-Novel Coronavirus (COVID-19). To keep up with the important work CMS is doing in response to COVID-19, visit their Current Emergencies website.

The new legislation does not apply to Medicaid or third party payers. However, most other payers, including Medicaid, provide some type of coverage for telehealth services, although some may require the patient to use a particular platform or telehealth company.

Telehealth laws, regulations and reimbursement policies vary by state. Some states have telehealth parity laws, which generally require private payers (and Medicaid programs) to cover telehealth services if those services would be covered if provided in-person. The Center for Connected Health Policy provides current telehealth laws and regulations for all 50 states and the District of Columbia.

If you provide an E/M service via telehealth, you will bill using the same CPT E/M codes as if you saw the patient in person. In addition, there are a number of other technology-based communication services short of a telehealth encounter that provide opportunities for patients to confer with and get advice from their physician.

One option is an online digital evaluation and management service in which the patient initiates contact with the physician through a secure platform or EHR portal or other secure application. These services are billed using CPT Codes 99421-99423 (see table below).  If the communication is performed by clinical staff (e.g., an RN), Medicare requires the use of G codes G2061-G2063. 

Payers may also pay for evaluation of a recorded image or video sent by a patient for evaluation billed with G2010 or for virtual check-in services (G2012) via telephone or other digital communication.

CodeDescriptionMedicare paymentBilling conditions
99421Online digital evaluation and management service for established patient, up to 7 days, 5-10 minutes$15.52
  • Report only once per 7 days
  • If E/M occurs within 7 days on either side, cannot bill. It is considered bundled into E/M service.
  • Does not cover telephone calls
  • Patient must initiate
  • Only established patients
9942211-20 minutes$31.04
  • Same as 99421
9942321 or more minutes$50.16
  • Same as 99421
G2061Online digital assessment by clinical staff (e.g., RN) 5-10 minutes$12.27
  • Same as 99421;
  • If provided by APRN or PA, bill 99421-99423
G206211-20 minutes$21.65
  • Same as G2061
G206321 or more minutes$33.92
  • Same as G2061
G2010Remote eval. of recorded video/images$12.27 
G2012Virtual check-in (5-10 minutes)$14.80
  • Can be via telephone

 

For more information about telemedicine for allergists, view the College’s Telehealth Toolkit. It includes the College’s Position Paper on the Use of Telemedicine for Allergists, info from allergists using telemedicine, physician licensure information and the College report on telemedicine platforms for allergists.

The Advocacy Council – we have you covered!

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