Email
Call 877-745-1489
TELEMEDICINE CODING AND BILLING
Providers and staff often ask about not only providing treatment to a patient electronically, but also about their time spent on following up with messages and phone calls with patients. To help, let’s break down the basic types of services that fall under telemedicine billing and coding.
“TELEHEALTH VISITS” coding and billing
These codes are the same E/M codes used for regular office visits. They must be provided over a synchronous (real-time) audio-visual system. Use POS code 10 (or 02 if the patient is not located in their home) and append modifier -95 to the code:
99201-99205: Outpatient visit for the evaluation and management of a new patient.
99211-99215: Outpatient visit for the evaluation and management of an established patient.
Another common example of services that can be provided via telehealth includes not only office-based E/M but also hospital- and nursing home-based E/M, psychotherapy, PT, OT, and SLP, and MNT.
We know of one idiosyncratic exception to the POS guideline. For OT services provided remotely to a patient in their home, if their primary insurance is Medicare, use the POS code that describes where the services are received by the patient, i.e. POS 12, but do use the -95 modifier.
Further, an exception to using the -95 modifier applies to the Medicaid HMO’s in Missouri. So for Healthy Blue and Home State, for instance, they do NOT accept the -95 modifier. The POS code of 10 would signify the procedures are provided by telemed.
“TELEPHONE E/M VISITS” coding and billing
Similar to above, but use these codes when you speak to the patient using an audio-only system. Must be an established patient, and use POS 10 and modifier -93.
Use these codes when the provider speaks to the patient regarding specific medical advice, and not for providing test results or confirming prescriptions. The time must be spent by a “qualified healthcare professional,” which is a provider who can bill an E/M service (MD, DO, DPM, OD, NP, PA, etc.).
99441: 5-10 minutes of medical discussion.
99442: 11-20 minutes of medical discussion.
99443: 21-30 minutes of medical discussion.
The reimbursement rates for these codes from the Missouri Medicare fee schedule, and the equivalent E/M code, are:
99441: $54.74, compared to 99212 at $55.07.
99442: $88.40, compared to 99213 at $88.73.
99443: $125.27, compared to 99214 also at $125.27.
These codes cannot be billed within the seven days following a previous E/M visit, nor that results in the patient receiving a full E/M visit within the next 24 hours or next available appointment.
In the latter case, the time spent on this visit should be added to the time spent on the next full E/M visit to determine the service level based on time.
Select these codes based only on the time of patient contact. Do not factor in any additional provider time as you would with a regular E/M code, i.e. time spent reviewing charts, ordering tests, etc.
“ONLINE DIGITAL VISITS”
Use these codes to bill time spent by providers to communicate with patients via patient portal messages. Since these services are performed by the provider and there is no real-time communication with the patient, bill as if they were performed in the office, i.e. use POS 11 and do NOT append a -93 or -95 modifier.
These codes are based on the cumulative time spent within a seven-day period. The date of service would be the first day of contact and would include the following six days. They must be provided to an established patient and be patient-initiated.
99421: 5-10 minutes of time spent.
99422: 11-20 minutes of time spent.
99423: 21 or more minutes of time spent.
If the service is provided by a “qualified non-physician healthcare professional” (a provider who cannot independently bill an E/M code, e.g. PT, OT, SLP, clinical psychologist), use these codes:
98970: 5-10 minutes of time spent.
98971: 11-20 minutes of time spent.
98972: 21 or more minutes of time spent.
These are the Missouri Medicare fees for these codes:
99421: $14.69
99422: $28.74
99423: $45.73
98970: $11.50
98971: $20.38
98972: $30.28
For a list of all codes that can be billed as telemed per CMS rules, download the file “List of Telehealth Services for Calendar Year 2024 (ZIP)” from this page:
https://www.cms.gov/medicare/coverage/telehealth/list-services
We hope this helps clear up some questions about telemedicine billing and coding. If your practice could benefit from our medical billing services, please call or email.
Reimbursement Specialists
info@stlmedicalbilling.com
314-514-5333
