May 6, 2020

Updated Guidance on Billing for Telehealth

By Jason Astrin, PA-C, MBA, DFAAPA, The US Oncology Network

On April 29, the CMS issued updated guidance on Medicare telehealth. CMS recognizes some Medicare beneficiaries do not have access to interactive audio-video technology required for Medicare telehealth services or choose not to use it even if offered by their practitioner. Therefore, CMS is waiving the video requirement for certain telephone E/M services and adding them to the list of Medicare telehealth services.

What does that mean for you?

• CMS is converting (crosswalking) RVUs and fees for Telephone Visits CPT codes 99441-99443 to Office Visits CPT codes 99212-99214.
  • For audio visits only: you would code and bill CPT codes 99441-99443. If you are utilizing audio/video synchronous communication, you would continue to report CPT codes 99212-99215
  • As before, you would choose the correct telephone CPT code based on time. CMS will crosswalk these charges to align with 99212-99214 reimbursement in the following manner:
    • 99441 (5-10 min) crosswalks to 99212
    • 99442 (11-20 min) crosswalks to 99213
    • 99443 (21 min or greater) crosswalks to 99214
• CMS has also included CPT codes 99354-99355/99356-99357 Prolonged Services for Office/Inpatient and CPT codes 99497-99498 Advance Care Planning as being eligible for “audio-only” technology.
  • Prolonged Services for Office/Inpatient, CPT codes 99354-99355/99356-99357 may be billed with CPT Telephone Visit CPT codes 99441-99443
  • 99354/99356 represent the first hour
  • 99355/99357 represent additional 30-min increments

These updates will be retroactively applied to services provided on March 1, 2020, or later.

Reference

Centers for Medicare and Medicaid Services. (2020). Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19. Retrieved from https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf

Related

Establishing Telemedicine During the COVID-19 Pandemic: Expert Advice for Oncology Advanced Practitioners (April 7)

An Expert Answers Your Questions on Telehealth During the COVID-19 Pandemic (April 24)

Read more from the  APSHO Advance: Special COVID-19 Series