Telehealth Coverage Expanded During the COVID-19 Pandemic

Under an interim rule enacted in Spring 2020, coverage of telehealth services has been expanded in response to a Public Health Emergency declared by the Centers for Medicare & Medicaid Services (CMS) in light of the COVID-19 pandemic. During a webcast hosted by the Association of Community Cancer Centers, Teri Bedard, BA, RT(R)(T), CPC, Director, Client Services, Revenue Cycle Coding Strategies, Cedar Park, TX, provided updates on coverage of telehealth services and the proper billing and coding for such services. In early October, the emergency declaration was renewed for another 90 days.

Coverage requires that a patient consent to be billed for a telehealth visit, and that options for visits have been explained to them. A consultant or qualified health provider must document the request for (and confirm/verify the need for) the inpatient telehealth consultation. The consultant then places this information in the patient’s medical record and lists the requesting physician. There must be both audio and video in real time between the physician and patient. Where a patient is located, where the physician is located, and the need for the visit by telehealth must be documented.

A provider can be at home while providing telehealth visits. When billing for the service, the place of service as well as where the visit would have occurred if in person must be indicated. List the address of the physician for the telehealth visit on the CMS1500 claim.

The expansion of telehealth services and change in supervision for office settings does not extend to drug administration codes.

When coding for expanded telehealth services, CMS is directing providers to use modifier 95, indicating that the service was provided by real-time audio/video communication between the patient and physician. Healthcare Common Procedure Coding System (HCPCS) codes such as G2012 require consent, as mentioned above, to bill for the visit.

For an initial inpatient telemedicine consultation, HCPCS telehealth codes are G04525 for a 30-minute visit, G0426 for a 50-minute visit, and G0427 for a 70-minute visit.

The approved telehealth services during the public health emergency are paid per the current Medicare Physician Fee Schedule, just as the in-person codes are paid. The Current Procedural Terminology (CPT) telephone codes 99441-99443 have been assigned work relative value units.

The relative value units for telephone calls are CPT codes 99441-99443. These were previously not covered by Medicare. During the public health emergency, they are being covered. Use HCPCS code G2012 for a phone call when a payer only accepts HCPCS code G2012 and not CPT code 99442. A 40-minute physician telephone visit (audio only) with a patient who has Medicare requires use of CPT code 99443.

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