Telehealth is a growing component of the digital transformation in healthcare. Facilities are utilizing telehealth to fill in the gaps in care especially in areas where there is limited or no access to care and/or access to certain specialties. It is also a useful tool for managing chronic illnesses, a point of access for urgent care and emergencies, and patient education to name a few of the areas where telehealth is growing. While access to care is greatly expanded for patients in underserved areas, it also offers the convenience of providing greater access to healthcare in general, including in the patient’s own home. It also eases the burden created by physician shortages and has the potential to reduce the cost of healthcare.
The Health Resources & Services Administration of the Department of Health & Human Services defines telehealth as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. The most common telehealth platforms include synchronous and asynchronous technologies like videoconferencing, store-and-forward imaging, email and remote-patient monitoring.
While there are still some barriers to expansion, telehealth is growing and that growth is projected to continue. Some examples of barriers include: restrictions on payment, licensure laws and regulations that limit the availability of telehealth across state lines, areas without adequate broadband service, and funding for the necessary technology.
In order to code telehealth services accurately, it is important to first recognize some of the terms used to describe the different modalities that describe how telehealth works. Here are a few definitions which can also be referenced at the following website: https://www.medicaid.gov/medicaid/benefits/telemed/index.html
Before reporting telehealth services, it is important to understand your individual state regulations and the requirements of individual payers as the varying requirements will impact how these services are reported. One example of a good starting point to learning about your state’s regulations is the Center for Connected Health Policy website at https://www.cchpca.org. However, make sure to check with your facility’s internal compliance and/or legal department to confirm any specific regulations that may be applicable to your state.
There are certain CPT codes that may be reported for telehealth services. In order to differentiate when a particular service is performed as telehealth versus face to face, Modifier 95, Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system, is appended to the appropriate CPT code. As noted in the narrative of this modifier, these services must be provided via synchronous (real time) services. You may refer to Appendix P in the CPT codebook for a list of codes that may be performed as a telemedicine service. These codes are also identified within the code book with a ★ symbol. In the table below are a few examples of CPT codes that may be reported for telehealth services.
|90791||Psychiatric diagnostic evaluation|
|90832||Psychotherapy, 30 minutes with patient|
|90960||End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month|
|92227||Remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral|
|93228||External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional|
|93298||Interrogation device evaluation(s), (remote) up to 30 days; subcutaneous cardiac rhythm monitor system, including analysis of recorded heart rhythm data, analysis, review(s) and report(s) by a physician or other qualified health care professional|
|96040||Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family|
|97802||Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes|
In addition, there are specific CPT codes in the Evaluation Management section of the CPT codebook under “Non-Face-to-Face Services” that include telephone services, Interprofessional Telephone/Internet/Electronic Health Record Consultations, Digitally Stored Data Services/Remote Physiologic Monitoring, and Remote Physiologic Monitoring Treatment Management Services. These codes are specifically designated as non-face-to-face services, and do not require a modifier 95. Please reference the CPT codebook for the guidelines pertaining to these codes.
HCPCS level II codes
HCPCS code Q3014, Telehealth originating site facility fee, is to be reported by the facility for Medicare patients to indicate the originating site. Modifiers GT, Via interactive audio and video telecommunication systems, and GQ, Via asynchronous telecommunication system, are appended to CPT or HCPCS codes as appropriate to capture interactive or asynchronous modalities. In addition, the place of service code to capture telehealth services is 02.
Below is a list of telehealth services that may be reported for Medicare beneficiaries and the corresponding HCPCS Level II G-codes representing these services. Please note: Medicare codes are updated annually.
|Service||HCPCS Level II Code|
|Telehealth consultations, emergency department or initial inpatient||G0425-G0427|
|Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs||G0406-G0408|
|Individual and group kidney disease education services||G0420-G0421|
|Individual and group diabetes self-management training services, with a minimum of 1 hour of in-person instruction furnished in the initial year training period to ensure effective injection training||G0108-G0109|
|Telehealth pharmacologic management||G0459|
|Individual and group medical nutrition therapy||G0270|
|Smoking cessation services||G0436, G0437|
|Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services||G0396, G0397|
|Annual alcohol misuse screening, 15 minutes||G0442|
|Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes||G0443|
|Annual depression screening||G0444|
|High-intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes||G0445|
|Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes||G0446|
|Face-to-face behavioral counseling for obesity, 15 minutes||G0447|
|Annual wellness visit, includes a personalized prevention plan of service (PPPS) first visit||G0438|
|Annual wellness visit, includes a personalized prevention plan of service (PPPS) subsequent visit||G0439|
|Telehealth consultation, critical care, initial, physicians typically spend 60 minutes communicating with the patient and providers via telehealth||G0508|
|Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth||G0509|
|Counseling visit to discuss need for lung cancer screening using low dose CT scan (LDCT) (service is for eligibility determination and shared decision making)||G0296|
|Comprehensive assessment of and care planning for patients requiring chronic care management||G0506|
|Prolonged preventive services||G0513, G0514|
This article is just a brief overview of telehealth services. As this trend continues to grow, Coding Clinic for HCPCS will provide additional information as it relates to reporting these services.
For additional information pertaining to telehealth you may wish to access the American Hospital Association’s (AHA) website at https://www.aha.org/center/emerging-issues/market-insights/telehealth.