Medicare Telemedicine Coding & Reimbursement Guidelines for COVID-19
Medicare Telemedicine Coding & Reimbursement Guidelines for COVID-19
CMS has expanded the benefit of telemedicine services on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act (CMS, 2020). CMS released the Medicare telemedicine coding and reimbursement guidelines for healthcare providers to use during the COVID-19 pandemic (CMS, 2020).
Reimbursement and Coding for Medicare Recipients
According to the CMS Medicare Telemedicine Health Care Provider Fact Sheet, reimbursement for these visits are considered the same as in-person visits and are paid at the same rate (CMS, 2020). In addition, the U.S. Department of Health & Human Services Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs (CMS, 2020).
Furthermore, services may be billed using CPT code 99421-99423 and HCPCS codes G2061-G2063, as applicable. Please see below the Summary of Medicare Telemedicine Services, taken from the CMS website (2020).
Lastly, reimbursement for a 5-10-minute call, 99441, will be the same rate as 99212-99442, and reimbursement for an 11-20-minute call will be the same rate as 99213 and 99443. A call greater than 20 minutes will have the same reimbursement rate as 99214.
Summary of Medicare Telemedicine Services
How would this affect Providers? And what are the HIPAA implications? See more here. Further details on the impact on coding due to the 1135 Waiver Authority and Coronavirus Preparedness and Response Supplemental Appropriations Act here. In addition, CMS clarified the risk adjustment criteria for coding telehealth services, which we outlined here.
Finally, let YES HIM Consulting help grow your coding team with education, coding support, and coder mentoring services. Contact us today!
Telehealth Resource Center:
- Get additional information on what constitutes a telehealth service, review our article Medicare Telehealth Services Now Included in Expanded Payment Protocol.
- Guidelines on telehealth codes and information about how to make the appropriate code selection: CMS Guidelines for Telehealth Coding & Billing During PHE.
- You can find detailed CMS guidance on telehealth policies here: Review the Temporary Physician-Based Telehealth Policies & Regulatory Revisions for COVID-19.
- Updated Special Edition (SE) MLN Matters article SE20011 Fee-for-Service response.
- Types of virtual services can be provided to Medicare beneficiaries – 1135 waiver and appropriate codes.
- Medicare telemedicine coding & reimbursement guidelines for covid-19 can be found here.
In addition, do you need to learn how to code the COVID-19 vaccines or telehealth services? Enroll in the latest COVID-19 training from YES HIM Education.
