Telemedicine is an excellent advancement for the healthcare system at large since it helps underserved communities get the medical attention they deserve even when a local physician is unavailable. This has proven especially important during the COVID-19 crisis because telemedicine allows healthcare providers to deliver essential medical services without placing an additional burden on medical infrastructure or compromising social distancing requirements.
While telemedicine is nothing entirely new, its boost in popularity due to the COVID-19 pandemic has led to more widespread use and acceptance. The guidelines of billing for telemedicine are still not concrete since they may vary from payer to payer. If your medical practice is currently offering or planning to offer this widely popular service, here are some essential tips and telemedicine billing requirements to consider.
- What is Telemedicine?
- How COVID-19 Has Impacted the Role of Telemedicine
- Telemedicine Billing Requirements Your Medical Practice Should Be Aware Of
- Best Practices for Billing for Telemedicine
- Maximize Your Telemedicine Services with NCG Medical
What is Telemedicine?
Telemedicine services are the practices of using technology to deliver medical care remotely. With telemedicine, a healthcare practitioner can use a telecommunications infrastructure to deliver care to a patient miles away.
Physicians use a variety of telecommunications technologies to deliver remote clinical services, such as mobile apps, online video conferencing and webcams, telephones, and even on-site kiosks. Since telemedicine involves private patient information, all telemedicine infrastructure technology needs to be HIPAA compliant and secure.
Since telemedicine services allow providers to care for patients from a distant location, it delivers both comfort and convenience for those who’d prefer virtual appointments. Patients no longer need to drive to their physician’s office or sit in a waiting room while sick. Instead, they can receive medical care without leaving their house. While this is especially beneficial for patients in remote areas, telemedicine has been impactful for those socially distancing and seeking medical care during the COVID-19 pandemic.
How COVID-19 Has Impacted the Role of Telemedicine
Until the COVID-19 pandemic, telemedicine was greatly underutilized. While telemedicine services have been available for many years now, hospitals and other providers had originally been slow to embrace the technology. Even before the pandemic crisis, there was substantial evidence that telemedicine can greatly increase the overall availability and efficiency of healthcare services. For instance, hospitals with telehealth tools not only see a larger volume of patients each day than hospitals without them (110.1 patients per day compared to 88.1 patients), but those patients also tend to have much shorter stays (4.7 days compared to 7.0 days).
The COVID-19 coronavirus outbreak has forced many healthcare providers who were either hesitant to provide telemedicine services or lacked the HIPAA-compliant IT infrastructure to reliably deliver them to greatly ramp up their telehealth capacity. Even in the first weeks of pandemic lockdowns, demand for virtual medical services grew exponentially, creating a tremendous opportunity for healthcare practices that have made investments in telehealth.
Due to social distancing and the spread of the pandemic, the U.S. witnessed over a 40 percent reduction in emergency department visits in April 2020 compared to the same period in 2019. At the same time, the multisite healthcare system Mayo Clinic witnesses a 10,880 percent increase in video appointments to patient homes. While 300 of Mayo Clinic’s providers had telemedicine visit infrastructure in place in 2019, by July 2020 this figure increased by 2,000 percent to more than 6,500.
The pandemic has also led to advancements in telemedicine services in Medicare and Medicaid. In March 2020, the Centers for Medicare & Medicaid Services (CMS) announced that a waiver would be used to expand Medicare reimbursements for telehealth and telemedicine services. As of January 1, 2021, Medicare finalized its telemedicine policy, resulting in coverage extending to 251 types of telehealth services. Since then, the demand for telehealth services has only increased and could eventually lead to significant changes in the way patients interact with the healthcare system even after the COVID-19 crisis passes.
Telemedicine Billing Requirements Your Medical Practice Should Be Aware Of
Despite the growing prominence of telehealth amid the coronavirus pandemic, medical billing for telemedicine can be complicated.
While the federal government, state Medicaid programs, and private insurers have all expanded their telemedicine coverage during the pandemic, medicare, Medicaid, and commercial payers all have different rules when it comes to billing for telemedicine. Many providers who offer telehealth services rely on a cash-pay-only approach. As such, there’s no set of one-size-fits-all advice for providers looking to grow their telehealth services list.
That means that sorting out the details of medical billing for telemedicine will continue to be a challenge for healthcare practices. Here are a few essential tips that can help them navigate the evolving reimbursement environment without incurring issues.
Get Friendly with GT Modifier Telehealth Codes
Medicare covers telemedicine services and reimburses them on the standard fee schedule. Use the appropriate CPT code with a “GT” modifier to indicate the “interactive telemedicine” component. Don’t let the similar GQ modifier, for “asynchronous communications,” trip you up – that one’s only intended for providers in demonstration projects in Hawaii and Alaska.
Similar for Medicaid…but Different
To identify, track, and reimburse for telehealth services, providers can select from a variety of HCPCS codes (T1014 and Q3014), CPT codes, and modifiers (GT, U1-UD), but medical billing and coding guidelines depend on their states’ rules. At present, 48 states and the District of Columbia now provide some form of Medicaid reimbursement for telehealth services.
For Private Payers, It’s a State-by-State Basis
States have had to create their own requirements when it comes to telehealth, and at last count, 37 states and the District of Columbia have some kind of private payer policy. Research whether your state is one of the 37 with a “telemedicine parity law,” which mandates commercial coverage of telehealth services the same as in-person ones. But as always, read the fine print – some states have restrictions.
The Big Five Have You Covered
Aetna, Humana, Blue Cross Blue Shield, Cigna, and United all offer some degree of coverage for telemedicine, but it’s policy-dependent (meaning many exclusions on lower-tier plans) and varies state-by-state. If you or your patient need specifics before a telehealth session, be sure to verify carefully.
When in Doubt, Check
The advice to verify carefully is even more important when it comes to smaller commercial payers. Go beyond a basic eligibility check to asking an actual representative about the telemedicine CPT code in question. If the rep says it’s covered, try to get that statement on record (with a reference number or other form of documentation) to dodge any potential billing disputes down the road.
Telemedicine is growing in popularity for more than just underserved populations due to the COVID-19 crisis. Thanks to advances in technology and the changing expectations of patients, telemedicine is increasingly being utilized by providers and accountable care organizations to bolster primary care delivery and keep consumer costs down. Watch for pilot programs in your area and stay engaged with the evolving laws; more positive telehealth program results will ultimately lead to stronger coverage and better reimbursement rates across the board.
Best Practices for Billing for Telemedicine
For the most streamlined billing process, it’s important to acknowledge and implement the correct telemedicine billing requirements. Here are some of the most commonly used CPT codes in medical billing for telemedicine services.
Medicare Telehealth Visits
These telemedicine billing codes will be used for a visit with a provider that uses telemedicine systems between the provider and patient. These telemedicine CPT codes are for both new and established patients.
CPT Codes 99201-99215
Use these codes for office or other visits.
CPT Codes G0425-G0427
These telemedicine billing codes are for telehealth consultations for both inpatient and emergency departments.
CPT Codes G0406-G0408
These codes are for follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs.
CPT Codes 99441 - 99443
Use these telemedicine CPT codes for telephone evaluation and management services by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment
Any of these telemedicine CPT codes cover a brief check-in with a physician virtually to decide whether an office visit or other service is needed. These codes are for established patients only.
HCPCS Code G2012
Brief virtual check-in by a physician who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
HCPCS Code G2010
Remote evaluation of recorded video and/or images submitted by an established patient, including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
For any communication between a patient and their healthcare practitioner through an online portal, use these telemedicine billing codes. These are for established patients only.
CPT Code 99421 - 99423
Online digital evaluation and management service, for an established patient, for up to 7 days.
CPT Code G2061 - G2063
Online assessment by qualified non-physician healthcare professionals.
Maximize Your Telemedicine Services with NCG Medical
Since the regulatory landscape for telemedicine is changing rapidly due to the outbreak of the COVID-19 pandemic and the influx of patients who would prefer remote clinical services,
having a trusted medical billing service available to guide your practice through those changes is more valuable than ever. By outsourcing medical billing to a third party, you can spend more time focusing on delivering quality care to patients during these difficult times and less time researching and worrying about which telemedicine services qualify for reimbursements.
At NCG Medical, we’ve long been advocates for using technology to streamline and improve healthcare practice management. Our team of medical billing specialists can help you evaluate the current reimbursement options for telehealth services to avoid claim denials and billing errors. Contact us today for a consultation.
...and if you need help from a medical billing company...