Telehealth CPT Codes, Billing, & More

Telehealth has gained in popularity over the past couple of years, with the largest growth happening over the course of the COVID-19 public health emergency. Now that the benefits of telehealth have been seen first-hand, it’s unlikely that we’ll move backward and away from this viable care option. As such, it’s imperative to have a working knowledge of the CPT codes, billing practices, and other reimbursement information moving forward so that you can effectively provide this important service to your patient population.

Telehealth CPT Codes

When billing for telehealth with CPT codes, the main thing you’ll want to remember is to use Modifier 95. This indicates that a telemedicine service has been delivered using a real-time audio-visual connection. To determine the specific codes that can be appended by Modifier 95, you’ll want to check Appendix P in the 2020 CPT® manual. This appendix gives a summary of the various CPT codes that can be used alongside Modifier 95 to report real-time telehealth services. It’s important to remember, though, that all procedures listed on Appendix P must be completed with an audio and video connection, so this will not work for other types of telehealth services such as store-and-forward.

Billing Tips for Telehealth

One of the main concerns that providers have with regard to telehealth is making sure that everything is billed properly so that revenue remains profitable. This is why it’s important to verify that telehealth is covered by a patient’s insurance prior to providing the service. When calling the insurance company to verify this eligibility, make sure you document the information you receive during the call so then you’ll be able to fight any possible denied claims with proof that you followed the payer’s specifications.

Next, make it a point to know the telehealth guidelines for each payer in general. Obviously this can feel time-consuming, particularly if your practice works with Medicare, Medicaid, and private payers, but this advance legwork along with the right questions can save a lot of time dealing with denied claims later. Some questions you’ll want to ask include:

• What healthcare services do you cover via telehealth?
• Which providers can bill for telehealth?
• Are there any restrictions on which patients qualify for telehealth?
• Is there a limit on how many telehealth visits a patient can have per year?

Just remember as you’re making these phone calls and noting responses, that the rules have been changing rapidly leaving even some payer representatives unsure of the changes. With that being said, it’s still possible that some of your claims may be denied initially. Just note what you were told and by whom so that you can use that information for any appeals.

While you’re talking to payers, make sure to double check what CPT codes are eligible for billing telehealth. Most payers are fine with using the appropriate E/M CPT codes along with a GT or 95 modifier, but other payers ask providers to bill with the telemedicine specific code of 99444. It’s better to know which code each payer prefers ahead of time.

Finally, work closely with your administrative staff to make sure that everyone understands how to effectively code for telehealth. Complete your documentation during the encounter and document exactly how long you spent providing the service. This will allow for proper coding of the encounter. Once your staff has coded the encounter, double check one more time before submitting that the codes are supported by the documentation.

Reimbursement for Telehealth

Out of pure necessity, the COVID-19 public health emergency changed the face of telehealth in the United States, at least on a temporary basis. Now, it seems that some permanent changes are finally on the horizon. The Centers for Medicare and Medicaid Services (CMS) has finalized a rule expanding telehealth coverage for Medicare beneficiaries. In this rule, 144 telehealth services have been temporarily added, along with several permanent telehealth services. The permanent services include home visits for established patients, care planning services, and group psychotherapy, while the temporary coverage extends certain services through the end of the calendar year in which the COVID-19 public health emergency comes to an end. CMS is not the only payer continuing to expand telehealth eligibility, with many private payers following suit. It’s important for providers, though, to be aware of which changes are permanent and which have sunset provisions attached to them so as not to get caught with claims that cannot be reimbursed. Again, check in with each payer you work with to find out their specific telehealth policies.

Clearly, telehealth has grabbed the attention of the medical field after the role it has played in keeping patients healthy through the recent public health emergency. After seeing how effective a tool telehealth can be, it’s easy to understand why it is likely to be here to stay in some form. This is why MicroMD is excited to offer Virtual Video Visits powered by Medpod, a physician to patient consultation service that provides a browser-based platform for easy, virtual visits – anytime, anywhere.

Featuring encrypted video, eligibility verification, and on-demand video translation and interpretation, Medpod is perfectly poised to help your practice keep up with the telehealth needs of the medical field today. For more information or to get started, visit www.micromd.com or call 1-800-624-8832.