Updated as of Feb. 14, 2023

What Is Telemedicine?

Telemedicine is defined as the remote diagnosis and treatment of patients by means of telecommunications technology. The terms telemedicine and telehealth are interchangeable. 

Regulatory Requirements

• Telemedicine rules apply to new and established patients.
• Patients must be notified that a claim will be submitted to the payer.
• Deductibles, co-payments and any remaining balances according to the remittance advice should be collected.
• HIPAA compliant platforms must be in place.
• Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers.

What Office Based CPT Codes Qualify for Telemedicine?

Telemedicine codes are identified by a star in front of the CPT code in the American Medical Association's CPT book or the Academy’s CPT: Complete Pocket Ophthalmic Reference. Here is a link to Center of Medicare & Medicaid Services (CMS) list of telehealth services that include Eye visit codes.

For calendar year 2023, CMS made several services that are temporarily available as telehealth services for the public health emergency (PHE), available through 2023 on a Category III basis. This extension will allow CMS to collect usage data in support of possible inclusion as permanent additions to the Medicare telehealth services list. 

Codes 92002, 92004, 92012 and 92014 are available through December 31, 2023. We anticipate CMS will address long term policy for its Medicare Telehealth Services List for CY 2024 and beyond as part of the CY 2024 Physician Fee Schedule proposed and final rules.

The appropriate level of E/M codes will be determined by either medical decision making (MDM) or physician time on the date of the encounter. Additional resources for E/M MDM can be found on aao.org/em.

Claims will continue to be billed with the place-of-service code that would be used had the services been furnished in-person. These claims will still require modifier –95 to identify they were furnished as telehealth services.

PLACE OF SERVICE	STRAIGHT-FORWARD	LOW	MODERATE	HIGH
Office - New	99202	99203	99204	99205
Office - Established	99212	99213	99214	99215
Initial Hospital Inpatient	99221	99221	99222	99223
Subsequent Hospital Inpatient	99231	99231	99232	99233

Telemedicine Phone Calls (Audio Only *)

99441	Telephone evaluation and management services by a physician or other qualified health care professional (nurse practitioner (NP) or physician assistant (PA) who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days not leading to an E/M service or procedure within the next 24 hours or soonest available appointment: 5-10 minutes of medical discussion
99442	11-20 minutes of medical discussion
99443	21-30 minutes of medical discussion

Modifier Application

The modifier conveying to the payer the exam is performed via telemedicine can vary by payer. Please check each individual payers’ website.

The Centers for Medicare and Medicaid Services (CMS) published a new modifier effective January 1, 2022. It is modifier -93 Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system.

Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional (nurse practitioner (NP) or physician assistant (PA) and a patient who is located away at a distant site from the physician or other qualified health care professional. The totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

*Modifier -93 must be appended to applicable exam codes indicating to Medicare Part B that the exam was performed via audio only telemedicine.

Modifier -95 must be appended to applicable exam codes indicating to Medicare Part B that the exam was performed as telehealth services.

Hybrid Exams

Telemedicine options improve patient capacity by reducing in-office schedules due to social distancing requirements and requests. Histories taken by phone and drive-up IOP checks are the new normal for many practices. Along with offering telemedicine appointments for minor conditions, expanding the encounter to include recent testing services may increase treatment options. Consider the following telemedicine hybrid scenarios:

Scenario #1: A 70-year female schedules a follow-up for nonexudative age-related macular degeneration.

• Staff obtains and documents history in the medical record.
• The patient is COVID-19 high-risk for severe illness; a telemedicine hybrid appointment is offered based on the clinic scheduling protocol.
• The physician reviews the chart and assesses the previous exam, visual acuity and findings.
• A retina OCT is ordered and documented in the medical record.
• The patient is scheduled for a visual acuity and OCT at the satellite office closest to her home.
• A subsequent telemedicine appointment with the ophthalmologist is scheduled at the next convenient date and time.
• At the satellite office, a technician tests visual acuity and conducts an OCT clinic, scheduled 30 minutes apart for social distancing. There is no wait for the patient and additional time is allotted for sanitation between tests.
• During the telemedicine appointment, the physician reviews the history, visual acuity, and OCT, discusses the findings and provides recommendations to the patient.

Scenario #2: A 62-year old male is recalled for a 4-month glaucoma check.

• After reviewing the patient’s chart and previous visual field and glaucoma OCT, the physician considers telemedicine options due to the lack of availability for a timely clinic appointment.
• The patient is scheduled for an IOP check at the next available drive-up clinic, with a follow-up telemedicine appointment with the physician.
• The follow-up telemedicine encounter is conducted. The physician reviews the IOP, discusses current medications and findings, and provides recommendations to the patient.

Note:

When utilizing telemedicine hybrid encounters consider the following:

• Physicians should direct the scheduling of telemedicine hybrid encounters based on patient-specific criteria or a comprehensive clinical scheduling protocol.
• All delegated testing services require a physician order that is documented prior to the encounter.
• Patients must verbally consent to the telemedicine encounter.