During the COVID-19 public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) issued waivers to significantly expand the use of reimbursable telehealth services. As a physician billing company, we keep track of these updates to help practices assign the correct codes to capture accurate diagnoses, procedures and services for appropriate reimbursement.
11 New Telehealth Services and Their CPT Codes
The use of telehealth rose dramatically since the beginning of the COVID-19 pandemic, according to Meg Barron, the AMA’s vice president of digital innovation. She estimated that 60% to 90% of physicians were using some sort of telehealth services in September.
On October 14, CMS announced the addition of 11 new services to the list of telehealth services covered by Medicare during the COVID-19. Practitioners can get reimbursed for these newly added telehealth services effective immediately and through the duration of the PHE.
The newly added 11 CPT® and HCPCS Level II codes payable under the Medicare Physician Fee Schedule (MPFS) are:
93797 Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session)
93798 …with continuous ECG monitoring (per session)
93750 Interrogation of ventricular assist device (VAD), in person, with physician or other qualified health care professional analysis of device parameters (eg, drivelines, alarms, power surges), review of device function (eg, flow and volume status, septum status, recovery), with programming, if performed, and report
95970 Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming
95971 …with simple spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional
95972 …with complex spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional
95983 …with brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional
+95984 …with brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure)
G0422 Intensive cardiac rehabilitation; with or without continuous ECG monitoring with exercise, per session
G0423 …with or without continuous ECG monitoring; without exercise, per session
G0424 …Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day
The federal government first expanded telehealth services covered by Medicare in March. CMS has added more than 135 services to the Medicare telehealth services list, including emergency department visits and initial inpatient visits since the PHE began. The Department of Health and Human Services (HSS) recently extended the duration of the public health emergency by 90 days, to expire Jan. 21, 2021.
In addition to keeping track of newly added telehealth services, physicians should also be aware about the Medicare-covered telehealth services that CMS proposes retain permanently and those that will be removed when the PHE ends. According to the proposed 2021 Physician Fee Schedule released in August, nine codes added during the COVID-19 crisis will become permanent and 74 codes will be removed when the PHE is over.
Telehealth Codes that will Remain after the PHE
CMS proposes to keep the following 9 telehealth services:
90853 Group Psychotherapy
99334-99335 Domiciliary, Rest Home, or Custodial Care services, Established patients
99347- 99348 Home Visits, Established Patient
99483 Cognitive Assessment and Care Planning Services
GPC1X Visit Complexity Inherent to Certain Office/Outpatient E/Ms
99417 Prolonged Services
96121 Psychological and Neuropsychological Testing
Telehealth codes that will be Removed when the PHE ends
99304-99306 Initial nursing facility visits, all levels (Low, Moderate, and High Complexity)
96136-96139 Psychological and Neuropsychological Testing
97161-97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507 Therapy Services, Physical and Occupational Therapy, all levels
99221-99223, 99238- 99239 Initial hospital care and hospital discharge day management
99468- 99472, 99475- 99476 Inpatient Neonatal and Pediatric Critical Care, Initial and Subsequent
99477-99480 Initial and Continuing Neonatal Intensive Care Services
99291-99292 Critical Care Services
90952-90953, 90956, 90959, 90962 End-Stage Renal Disease Monthly Capitation Payment codes
77427 Radiation Treatment Management Services
99284-99285 Emergency Department Visits, Levels 4-5
99324-99328 Domiciliary, Rest Home, or Custodial Care services, New
99341- 99345 Home Visits, New Patient, all levels
99217-99220, 99224-99226, 99234-99236 Initial and Subsequent Observation and Observation Discharge Day Management
While CMS has eased the restrictions pertaining to telehealth services, there are several requirements that must be met in order to bill telehealth services. Provider payers vary by state, plan and changing policies. Telehealth services must be billed using the appropriate CPT, POS codes and modifiers. Partnering with an experienced physician billing service provider can help physicians navigate the new telehealth payment landscape, submit clean claims and get paid.