Disclaimer #1: Please consult CMS.gov before participating in telemedicine as information on telemedicine CPT codes changes regularly. This article was updated from it's original publication as The Ultimate Guide to Telemedicine CPT Codes in 2020.
Whether you’ve been doing telemedicine for years or just recently found a telemedicine job you love, telemedicine CPT codes have been changing faster than most of us can keep up with. In the next few paragraphs, I’ll try to briefly share some of the changes to telemedicine CPT codes during the COVID-19 pandemic and explain how I’ve changed my practice to offer telemedicine visits to our patients. Hopefully, these changes mean telemedicine jobs will be viable options through 2021 and far into the future.
One of the most frequent questions we get is ‘Does Medicare pay for telemedicine visits?’ Fortunately for us, the answer is yes! As of 3/17/2020, the Centers for Medicare and Medicaid Services have revised both HIPPA requirements and telemedicine reimbursement in the face of the demands posed by the COVID-19 pandemic.
“Starting on March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances. These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.”
As a requirement, providers must use “an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home.”
Previously, telehealth required the use of very specific platforms (Teladoc, Zoom for Healthcare providers, VSee, Doxy.me, Skype for Business, etc.) that provided end-to-end encryption. However, this HIPPA requirement has been waived during the duration of the emergency for healthcare providers that serve patients “in good faith.”
As of now, healthcare providers may use “popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype.” Guidance from CMS advises that providers “are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.” Providers should make every effort to make sure calls are conducted in a quiet, private area to maintain patient privacy.
Below are the codes that can be used for the various types of visits:
If patients are unwilling or unable to use an audiovisual telecommunications platform and would like to use telephone only, billing codes are available for telephone only encounters:Our practice is generally using the above telemedicine documentation guidelines listed above for telephone encounters for ALL telehealth encounters.
One important change in 2020 is that the telephone codes for 99441 to 99443 are now reimbursed for the E/M clinic codes of 99212 to 99214.
Thus, the wRVU (relative value units) of telephone only reimbursements during the pandemic have essentially doubled. Previously, telephone encounters were only for follow-up patients, but as of the time of writing this you can use it for both new patients and follow-up visits.
(As an aside, for online asynchronous telemedicine reimbursements, you will likely only receive reimbursement in certain states, such as Alaska or Hawaii.)
For the patients at our practice who are uncomfortable coming into the office or for those we decided are high risk and that we would prefer stay home for their own safety we believe telehealth is a robust tool that can allow us to meet the healthcare needs of our patients while shielding them from unnecessary exposure to COVID-19. We have begun reaching out to high-risk patients to recommend telehealth visitations. For all other patients we have, at minimum, begun proactively offering telehealth appointments to with a simple algorithm:
When calling patients to confirm their appointment with the doctor, please offer them the option for a telemedicine visit. Below is an example we use at my office (quote taken from an email from our practice manager):
"If they opt for a telemedicine visit, they have two options:
o Doxy.me-Requires an active email along with access to internet in a quiet, private space.
o Facetime-Requires phone or internet service in a quiet, private space.
At our practice, the preferred platform for engaging in telehealth is Doxy.me. Although Doxy.me makes a Professional platform for Healthcare Providers with lots of features with end-to-end encryption for $35/month, the free application is HIPPA compliant. The platform is available at www.doxy.me. The professional version can also be purchased in bulk for your entire clinic at a discount.
The advantage of utilizing this platform over simple FaceTime or Skype is that it allows for waiting rooms, high definition video (in professional version), and screen-sharing to discuss labs (if scanned into your EMR). Given the low cost for the office, we use the professional version.
Again, I would recommend reading the “Medicare Telemedicine Healthcare Provider Fact Sheet” available at cms.gov prior to engaging in telehealth. Please continue to check there for any additional changes in the coming days and weeks.
We hope you will consider utilizing telemedicine in your practice in the near future to meet the needs of your patients and protect our most vulnerable patients from unnecessary exposure. The relaxed HIPAA rules and simplified reimbursement codes have made it substantially easier to participate.
I hope this guide was useful to you, thanks for reading!
Disclaimer #2: Seriously, consult the CMS.gov website and talk to your biller before participating in telemedicine!