Telehealth Resource Center for Revised PHE Coding & Billing Policies Due to COVID-19

Telehealth Resource Center for Revised PHE Coding & Billing Policies Due to COVID-19

Telehealth Resource Center:

• AMA releases new CPT code modifier for audio-only telehealth.
• What are the new challenges presented in telehealth coding? Review them here.
• Do you know what the future of telehealth entails? Check out the research here.
• Four telehealth CPT codes removed from CMS Medicare coverage list.
• Eleven new telehealth services added to Medicare reimbursement list.
• Overcome these common telehealth coding and billing challenges.
• 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.
• Detailed CMS guidance on telehealth policies can be found 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.

The Center for Medicare & Medicaid Services (CMS) expanded the payment guidelines for professional telehealth services provided to Medicare beneficiaries during the Public Health Emergency (PHE) declared for COVID-19 (CMS, 2020). CMS deemed the temporary protocol expansion necessary to aid healthcare reimbursement, and will be active only during the PHE. Furthermore, to keep coders and auditors up-to-date on the expanded services and reimbursement guidelines, YES HIM Consulting has gathered all the latest updates to form a telehealth resource center.

What is Telemedicine?

There are 3 types of telemedicine services. One type is a “Telehealth Visit,” where the provider uses “an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home” (CMS, 2020). The other 2 types of remote services are “Virtual Check-in” and “E-visits,” which are non-face-to-face visits with a physician facilitated by online patient portals or technology-based communication systems (CMS, 2020). Providers can perform these services anywhere, but the patient must be established with their physician. In addition, audio-only phone calls qualify as telehealth services, using codes 99441-99443 for reimbursement. For more information about what constitutes a telehealth service, review our article “Medicare Telehealth Services Now Included in Expanded Payment Protocol.”

How do I code & bill Telehealth Services?

During the PHE, E/M telehealth services will be based on MD or time. Coders will use code G2010 for the remote evaluation of a patient’s submitted photos or videos (AASM, 2020). Furthermore, code G2012 will cover technology-based communications between a physician and patient (CMS, 2020).

Additional telehealth codes and information about how to make the appropriate code selection is available in our article, “CMS Guidelines for Telehealth Coding & Billing During PHE.”

Were there any Policy & Regulatory Revisions?

The PHE caused CMS to lessen many supervision requirements. CMS now allow providers to supervise patients using audio and visual telecommunications equipment. The agency includes inpatient rehabilitation facilities (IRFs), inpatient and outpatient hospital services, and teaching facilities in this update. CMS has added telehealth modifiers to aid reimbursement claims; they are 95, G0, GT, and GQ.

The detailed CMS guidance on telehealth policies can be found in our article, “Review the Temporary Physician-Based Telehealth Policies & Regulatory Revisions for COVID-19.”

What about the Fee-for-Service Response?

Additionally, our telehealth resource center includes the updated Special Edition (SE) MLN Matters article SE20011 Fee-for-Service response. This highlights the issuance changes to blanket waivers and beneficiary notices (CMS, 2020). To issue notices to patients in quarantine, someone who can safely enter the patient’s room may deliver a hard copy. Payers may send an email copy if it is impossible to safely deliver a hard copy.

Furthermore, the list of updated blanket waivers is available here. For more CMS guidance on telehealth fee-for-service response, read our article, “Updates for Medicare Fee for Service (FFS): CMS MLN Matters Special Edition Article.”

Review the 1135 waiver and appropriate codes, types of virtual services and providers, and the reimbursement guidelines on the YES Blog.

Let YES HIM Consulting assist you with any coding, auditing, or consulting needs that you may be challenging your organization and team. Contact YES today for a proposal!

Lastly, 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.