In the wake of the COVID-19 pandemic, an increasing number of patients have embraced the utilization of telehealth as a means to obtain medical care, access behavioral health services, and effectively manage chronic conditions. As a result, healthcare providers have encountered an unprecedented surge in demand for telehealth appointments, experiencing a substantial upswing in patient interest and reliance on remote patient monitoring services.
Telehealth has evolved significantly since the start of the COVID-19 pandemic over three years ago. This guide provides an overview of the 2023 telehealth billing guidelines, upcoming changes, and a handy cheat sheet of approved telehealth codes by the Centers for Medicare and Medicaid Services (CMS).
Accurately keeping tabs on telehealth reimbursements is vital for your healthcare organization’s financial success. We’ve compiled a handy list of telehealth CPT codes to assist you in navigating the billing process for your care program.
| Codes | Category | Code Description | Patients |
| 99201 – 99215 | Telehealth Visits | Visits conducted in an office or alternative outpatient setting | New and established patients. |
| 99421 –99423 | Virtual Visits | An online digital assessment and management service, available for a duration of up to 7 days, with a cumulative time span within the 7-day period. | Established patient. |
| 99441 –99443 | Telephone Services | The evaluation and management of a patient, parent, or guardian by a physician or another qualified healthcare professional involves reporting services that are not linked to a previous 7-day evaluation and management service, nor do they lead to an upcoming evaluation and management service or procedure within the next 24 hours or the earliest available appointment. | Established patient. |
| 99446 – 99449 | Interprofessional Telephone/Internet/Electronic Health Record Consultation | Providing an evaluation and management service, a consultative physician offers both verbal and written reports to the patient’s requesting/treating physician or another qualified healthcare professional. Each code encompasses time for discussing and reviewing medical consultations. | – |
| 99451 | Interprofessional Telephone/Internet/Electronic Health Record Consultation | Offered by a consultative physician, this service encompasses assessment and management, featuring a written report for the patient’s treating/requesting healthcare professional or other qualified care provider, with a minimum of 5 minutes dedicated to medical consultative time. | – |
| 99452 | Interprofessional Telephone/Internet/Electronic Health Record Consultation | The treating/requesting physician or another qualified healthcare professional delivers referral service(s), allocating a duration of 30 minutes. | – |
| G0425 – G0427 | Telehealth Visits | Consultations, trips to the emergency department, or initial stays in the hospital. | New and established patients. |
| G2010 | Virtual Check-Ins | The assessment of recorded video and/or images submitted by a returning patient (e.g., store and forward), and conducted remotely, involves interpretation and subsequent follow-up with the patient within 24 business hours. These evaluations are separate from any related evaluation and management service within the past 7 days and do not result in an upcoming evaluation and management service or procedure within the next 24 hours or earliest available appointment. | Established |
| G2012 | Virtual Check-Ins | Provided by a physician or another qualified healthcare professional, this service involves a brief communication utilizing technology. The healthcare professional can report evaluation and management services that are separate from any related evaluation and management service within the past 7 days and do not lead to an upcoming evaluation and management service or procedure within the coming 24 hours the earliest available appointment. This service’s duration of medical discussion ranges from 5 to 10 minutes. | Established patient. |
| G2252 | Virtual Check-Ins | Rendered by a medical practitioner or another qualified healthcare expert, this service entails a concise interaction employing technology. The healthcare professional can document evaluation and management services that are distinct from any related evaluation and management service conducted within the preceding 7 days and do not result in a forthcoming evaluation and management service within the next 24 hours or the earliest obtainable appointment. The duration of the medical discussion for this service varies from 11-20 minutes. | Established patient. |
| G2250 | Virtual Check-Ins (For providers who cannot independently bill for E/M services) | The remote evaluation of recorded video and/or images provided by a returning patient (e.g., store and forward) comprises interpretation and subsequent follow-up with the patient within 24 business hours. This evaluation is distinct from any related service within the preceding 7 days and does not result in a service or procedure within the next 24 hours or the earliest available appointment. | Established patient. |
| G2251 | Virtual Check-Ins (For providers who cannot independently bill for E/M services) | A concise communication technology-based service administered by a competent healthcare professional who is unable to document evaluation and management services. This service is separate from any related E/M service within the previous 7 days and does not lead to a service or procedure within the next 24 hours or the earliest available appointment. The duration of medical discussion for this service ranges from 5 to 10 minutes. | Established patient. |
| G2061 – G2063 | Virtual Visit | Digital evaluation performed by a capable non-physician healthcare professional. | Established patient. |
| G0406-G0408 | Telemedicine Services | Telehealth-based consultation for ongoing inpatient follow-up. | Established patient. |
| G0425-G0427 | Telemedicine Services | Emergency department consultation conducted through telehealth. | New patient. |
| G0508, G0509 | Telemedicine Services | Critical care telehealth consultation. | New and established patients. |
The recent burgeoning surge of telehealth implementation has resulted in regulatory alterations and an expansion in telemedicine coverage, thereby greatly benefiting healthcare providers—given that reimbursement is executed with utmost accuracy.
Below are the foremost four frequently encountered blunders in telehealth billing and adept measures to avoid them.
With the growing digital storage of vital patient documents, the prevalence of healthcare data breaches is rising. Providers involved in transmitting consumer data must prioritize investments in robust cybersecurity measures.
Safeguarding sensitive information through advanced technological solutions and implementing strict access controls are crucial steps toward addressing this issue and protecting patient privacy.
Integrating, electronic medical records (EMR) with telehealth technologies, can be quite costly and time-consuming. The lack of integration often leads to the need for duplicate documentation, which takes up valuable time and increases the chances of errors and employee dissatisfaction.
Ensuring HIPAA compliance and safeguarding sensitive data necessitate implementing highly secure exchange methods. As telehealth grows, new care systems must prioritize maintaining or enhancing communication between doctors and patients, strengthening relationships, and improving healthcare effectiveness and efficiency.
One of the biggest concerns in telehealth revolves around the limited reimbursement options and amounts offered by CMS and commercial payers, especially compared to traditional in-person consultations. Although payment parity rules exist in 28 states, their enforcement mechanism is lacking.
The Centers for Medicaid and Medicare Services temporarily increased reimbursement during the pandemic, but the duration of this modification remains uncertain. It is reasonable to anticipate the expansion of advantages, insurance coverage, and payment options for telehealth services as consumerism gains prominence and evidence supporting the benefits of telehealth services accumulates. CMS and other payers are expected to offer more claimable codes.
The lack of seamless platform integration can lead to disruptive interruptions in patient care. Imagine a scenario where a patient receives telemedicine services from one provider but decides to switch to another for their next e-visit. In such cases, the new physician may lack access to vital information necessary to accurately diagnose the patient’s illness. As a result, this mismatch creates perplexing billing confusion, where incorrect data is inadvertently fed into the system, ultimately leading to a failure to obtain full reimbursement.
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