• Coding for Phone Calls, Internet and Telehealth Consultations


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    Updated May 22, 2020

    Telemedicine has been available in some form since 2017. During the COVID-19 public health emergency (PHE), both federal and commercial payers have added waivers to expand coverage. Each payer will have their own end date. 

    What You Need to Know:

    • Telemedicine refers to a group of services that may be provided to a patient without any physical patient contact. Services may be provided via a telephone (audio) connection, via some type of online communication such as a patient/provider portal, or via email interactions between the patient and practitioner. 
    • Telehealth refers to a distinct level of services that have traditionally been performed via a face-to-face interaction between the patient and physician. Telehealth allows the interaction to still occur face-to-face; however, it can be achieved via audio and video connections.
      • Important:  Effective April 30, CMS added the Eye visit codes to the list of covered exams during the COVID-19 public health emergency (PHE). Documentation requirements remain the same.
        • 92002 and 92012 are achievable via virtual face-to-face interaction. Place of service is 11 and append modifier -95.
        • This expansion of coverage may be unique to CMS.
    • Time involving staff who are not licensed to practice medicine can’t be billed for or factored into time-based coding options.
      • Important:  Effective April 30, CMS includes the technician code 99211 as a telemedicine code option.
        • Applies to new and established patients.
        • There must be a documented order from the physician indicating what should be addressed during the staff/patient encounter by phone.
        • Supervision may be virtual.
        • 99211 continues to be bundled with all testing services performed the same day.
        • A physician visit performed on the same day of 99211 would not be separately billable.
    • Commercial and Medicaid programs do have their own rules regarding coverage of codes, modifiers and place of service (POS). Please check every commercial and Medicaid website for specific information.
    • All information applies to new and established patients.
    • Patients must be notified that a claim will be submitted to the payer.
    • Phone call codes G2012 or 99441-99443 should not be reported when originating from a related E/M service provided within the past seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. Should not be reported for postop visits. (Important:  Effective April 30, CMS increased the allowable of 99441 to 99212, 99442 to 99213 and 99443 to 99214. The increase will be automatically made to March 1 dates of service. These codes are reported for medical discussion with the physician and should not be used for administrative or other non-medical discussion with the patient. Learn more.)
    • E-visit codes 99421-99423 include up to seven days cumulative time. These codes are not to be used for scheduling appointments or conveying test results.
    • Evaluation of Video or Images code G2010 should be used for remote evaluation of recorded video and/or images submitted by a new or established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service should be provided within the previous seven days nor leading to an E/M services or procedure within the next 24 hours or soonest available appointment. G2010 and G2012 may be submitted the same day.

    For more information, watch "The Ease of Implementing Telemedicine into Your Practice." Plus, view "Telemedicine: Try It. You'll Like It," a presentation by Academy Secretary for Federal Affairs David B. Glasser, MD. It's part of the Academy's one-hour webinar, "Q&A with Solos and Small Group Practices on the Economic Impact of the COVID-19 Pandemic" and starts at the 0:17:50 mark.

    Overview of Four Covered Options for Medicare Part B Patients

    There are four options for telehealth and other communications-based technology services. This information is based on guidelines from the Centers for Medicare & Medicaid Services.

    Option 1: Telehealth Virtual Two-Way Communication Between Physician and Patient

    Level of exam is based on either physician total time on the date of the encounter (listed below) or medical decision making (MDM) during the PHE.

    CPT Code
    New Patients
    Level of MDM Time Modifiers Place of Service
    99201 Straightforward 10 min

    95

    11
    99202

    Straightforward

    20 min 95 11
    99203

    Low

    30 min 95 11
    99204 Moderate 45 min 95 11
    99205 High 60 min 95 11

    Eye Visit Codes

    CPT Code Description Modifiers Place of Service
    92002 New patient
    Intermediate exam
    95 11
    92004 New patient
    Comprehensive exam
    95 11
    CPT Code
    Established Patient
    Level of MDM Time Modifiers Place of Service
    99211 Doesn't qualify 5 min 95 11
    99212 Straightforward 10 min 95 11
    99213 Low 15 min 95 11
    99214 Moderate 25 min 95 11
    99215 High 40 min 95 11

    Eye Visit Codes

    CPT Code Description Modifiers Place of Service
    92012 Established patient
    Intermediate exam
    95 11
    92014 Established patient
    Comprehensive exam
    95 11

    Option 2: Physician/Patient Phone Calls

    CPT Code
    Time Modifiers Place of Service
    G2012 5-10 min N/A 11
    99441 5-10 min N/A 11
    99442 11-20 min N/A 11
    99443 21-30 min N/A 11

    Important:  Effective April 30, CMS increased the allowable of 99441 to 99212, 99442 to 99213 and 99443 to 99214. The increase will be automatically made to March 1 dates of service. These codes are reported for medical discussion with the physician and should not be used for administrative or other non-medical discussion with the patient. Learn more.


    Option 3: E-Visits for Online Digital Services

    CPT Code
    Time Modifier Place of Service
    99421 5-10 min N/A 11
    99422 11-20 min N/A 11
    99423 21 or more min N/A 11

    Option 4: Evaluation of Video and Images

    CPT Code
    Definition Modifier Place of Service
    G2010 Remote evaluation of recorded video and/or images submitted by a new or established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours N/A 11

    Additional Resources