TeleHealth CPT codes

Navigating Telehealth CPT Codes: A Comprehensive Guide

Telehealth has revolutionized the way healthcare is delivered, providing convenient access to medical services remotely. With the increasing popularity of telehealth, understanding the associated Current Procedural Terminology (CPT) codes is essential for healthcare providers and billing professionals. This comprehensive guide aims to demystify telehealth CPT codes, providing insights into the key codes used for billing and reimbursement in remote care settings.

Telehealth CPT codes are used in billing for virtual healthcare services provided via audio, video, or other electronic communication methods. These codes enable healthcare providers to accurately document and bill for telehealth encounters, ensuring proper reimbursement for remote care services. The following are some common telehealth CPT codes and their descriptions;

Telehealth CPT Codes Cheat Sheet

  1. 99441-99443: These codes are used to bill for brief online digital evaluation and management services.
  • 99441: Telephone E/M service for 5-10 minutes of medical discussion.
  • 99442: Telephone E/M service for 11-20 minutes of medical discussion.
  • 99443: Telephone E/M service for 21-30 minutes of medical discussion.
  1. 99421-99423: These codes cover online digital evaluation and management services for established patients.
  • 99421: Up to 7 days, 5-10 minutes.
  • 99422: 11-20 minutes.
  • 99423: 21 or more minutes.
  1. 99201-99215: Evaluation and management (E/M) CPT codes can also be used for telehealth visits, depending on the complexity and nature of the encounter. These codes cover office or other outpatient services, including new and established patient visits.
  2. G2010: This code is used for remote evaluation of recorded video and/or images submitted by an established patient.
  3. G2012: This code covers virtual check-in services, involving brief communication technology-based assessments by a healthcare provider.

Audio-Only Telehealth CPT Codes

Audio-only telehealth, particularly valuable for patients with limited internet access or technology resources, requires specific CPT codes for billing and reimbursement. Common CPT codes for audio-only telehealth include;

  • 98966-98968: These codes are used for telephone assessment and management services, covering various time increments.
  • 99441-99443: While primarily intended for digital evaluation, these codes may also apply to telephone-based services for brief medical discussions, covering various time increments.
  • G2012: This code covers virtual check-in services, including brief communication technology-based assessments, suitable for audio-only encounters.

Telehealth CPT Codes for Behavioral Health

Behavioral health services delivered via telehealth require specialized CPT codes to accurately capture the complexity of psychiatric assessments and interventions. Key CPT codes for telebehavioral health include;

  • 90791-90792: These codes cover psychiatric diagnostic evaluations, including face-to-face assessment and history gathering.
  • 90832-90838: CPT codes for psychotherapy services, ranging from individual to family therapy sessions, can be used for telehealth encounters.
  • 96156-96158: These codes are specific to health and behavior assessment and intervention services, which may be delivered remotely via telehealth platforms.

Inpatient Telehealth CPT Codes

Telehealth is increasingly utilized within inpatient settings to facilitate remote consultations, follow-up visits, and specialty care delivery. CPT codes applicable to inpatient telehealth services include:

  1. 99451-99452: These codes cover inter professional telephone/internet/electronic health record consultations provided to inpatients.
  • 99451: Reported by consultant accessing data via EHR, alongside telephone/internet.
  • 99452: Reported by requesting/treating physician/QHP (e.g., primary care physician).
  1. 99231-99233: Subsequent hospital care codes may be used for telehealth encounters involving the management of inpatient services and progress assessment.
  2. 99446-99449: CPT codes for care coordination services, including communication with other treating physicians or facilities, can apply to inpatient telehealth encounters. discussions covering various time increments

Telehealth CPT Codes for Medicare

Medicare reimbursement policies for telehealth services have evolved, particularly in response to the COVID-19 pandemic. Understanding Medicare-specific telehealth CPT codes is essential for compliant billing and reimbursement. Notable telehealth CPT codes for Medicare include;

  1. G0406: Follow-up inpatient consultation, limited, 15 minutes via telehealth
  2. G0407: Follow-up inpatient consultation, intermediate, 25 minutes via telehealth
  3. G0408: Follow-up inpatient consultation, complex, 35 minutes via telehealth
  4. G0425: Telehealth consultation, emergency department or initial inpatient, 30 minutes via telehealth
  5. G0426: Telehealth consultation, emergency department or initial inpatient, 50 minutes via telehealth
  6. G0427: Telehealth consultation, emergency department or initial inpatient, 70 minutes or more via telehealth
  7. G0508-G0509: Telehealth consultation, critical care, for both new and established patients.

Billing and Reimbursement Considerations: When billing for telehealth services, healthcare providers must ensure proper documentation of the encounter, including the type of service provided, duration, and patient consent for telehealth. Additionally, it’s essential to verify payer policies regarding coverage and reimbursement for telehealth services, as regulations may vary depending on the payer and state.

Telehealth Expansion During COVID-19: Amid the COVID-19 pandemic, telehealth utilization surged, prompting temporary expansions in telehealth coverage and reimbursement policies. Many payers relaxed restrictions on telehealth services, allowing for broader access and reimbursement for virtual care. However, healthcare providers must stay informed about evolving telehealth regulations and policy changes to ensure compliance and optimize reimbursement.

Future of Telehealth CPT Codes: As telehealth continues to evolve, so will the landscape of telehealth CPT codes and billing practices. Healthcare stakeholders must adapt to ongoing changes in telehealth regulations, technology advancements, and patient preferences to effectively leverage telehealth for improved access to care and patient outcomes.

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