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Great Healthcare Common Procedure Coding!

For Telephone, E-mail, and Telehealth Services

Telephone Services (Physicians)

Telephone services are non-face-to-face evaluation and management (E/M) services provided to a patient using the telephone by a physician or other qualified health care professional, who may report evaluation and management services. These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient.

99441   Telephone evaluation and management service 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; 5-10 minutes of medical discussion     [$13.97  (N)]

99442    11-20 minutes of medical discussion   [$27.23 (N)]

99443    21-30 minutes of medical discussion   [$40.13(N)]

Care Plan Oversight Services

Care plan oversight services are reported separately from codes for office/outpatient, hospital, home, nursing facility or domiciliary, or non-face-to-face services. The work involved in providing very low intensity or infrequent supervision services is included in the pre- and post-encounter work for home, office/outpatient and nursing facility or domiciliary visit codes.

99374     Supervision of a patient under care of home health agency (patient not present) in home, domiciliary or equivalent environment (eg, Alzheimer’s facility) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (eg, legal guardian) and/or key caregiver(s) involved in patient’s care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes [$70.44   (B)]

99375   30 minutes or more  [$105.69 (B)]

99377   Supervision of a hospice patient (patient not present)  (Requires same as 99374-99375) 15-29 minutes  [$70.94 (B)]

99378   30 minutes or more  [$106.19 (I)]

Domiciliary, Rest Home (eg, Assisted Living Facility), or Home Care Plan Oversight Services

99339     Individual physician supervision of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (eg, legal guardian) and/or key caregiver(s) involved in patient’s care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes   [$78.10 (B)]

99340   30 minutes or more    [$109.63 (B)]

Chronic Care Management Services

Chronic care management services are patient centered management and support services provided by physicians, other qualified health care professionals and clinical staff to an individual who resides at home or in a domiciliary, rest home, or assisted living facility. These services typically involve clinical staff implementing a care plan directed by the physician or other qualified health care professional. These services address the coordination of care by multiple disciplines and community service agencies. The reporting individual provides or oversees the management and/or coordination of services, as needed, for all medical conditions, psychosocial needs and activities of daily living. Time spent is that of clinical staff.

99490   Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

  • multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient;
  • chronic conditions place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline:
  • comprehensive care plan established, implemented, revised, or monitored. [$40.84 (A)]

99487     Complex chronic care management services, with the following required elements:

  • multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
  • chronic conditions place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline,
  • establishment or substantial revision of a comprehensive care plan,
  • moderate or high complexity medical decision making;
  • 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. [$0.00  (B)]

99489    each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition 99487)    [$0.00 (B)]

Transitional Care Management Services

These services are for a new or established patient whose medical and/or psychosocial problems require moderate or high complexity medical decision making during transitions in care from an inpatient hospital setting (including acute hospital, rehabilitation hospital, long-term acute care hospital), partial hospital, observation status in a hospital, or skilled nursing facility/nursing facility, to the patient’s community setting (home, domiciliary, rest home, or assisted living). TCM commences upon the date of discharge and continues for the next 29 days. TCM is comprised of one face-to-face visit within the specified timeframes, in combination with non- face-to-face services that may be performed by the physician or other qualified health care professional and/or

99495    Transitional Care Management Services with the following required elements:

  • Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge
  • Medical decision making of at least moderate complexity during the service period
  • Face-to-face visit, within 14 calendar days of discharge [$164.82 (A)]

99496   Transitional Care Management Services with the following required elements:

  • Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge
  • Medical decision making of high complexity during the service period
  • Face-to-face visit, within 7 calendar days of discharge [$232.52 (A)]

Telephone Services (Non-Physician)

Telephone services are non-face-to-face assessment and management services provided by a qualified health care professional* to a patient using the telephone. These codes are used to report episodes of care by the qualified health care professional initiated by an established patient or guardian of an established patient.

98966   Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion   [$13.97  (N)]

98967    11-20 minutes of medical discussion   [$27.23  (N)]

98968    21-30 minutes of medical discussion   [$40.13  (N)]

The term “qualified healthcare professional” is defined as staff that can independently report services, such as physician therapists, speech therapists, occupational therapists, chiropractors, registered dieticians, etc. It excludes clinical staff such as RNs, LPNs or those who only work under the supervision of a physician or other qualified professional, but cannot bill on their own.

Interprofessional Consultation

Interprofessional consultations are services requested by telephone or Internet by a physician or other qualified health care professional seeking a consultant’s expert opinion without a face-to-face patient encounter with the consultant. To capture the service rendered, the specialist will report a code for interprofessional consultation. The codes are:

99446    Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician/qualified health care professional; 5-10 minutes of medical consultative discussion and review [N/A]

99447    11-20 minutes of medical consultative discussion and review [N/A]

99448    21-30 minutes of medical consultative discussion and review [N/A]

99449    31 minutes or more of medical consultative discussion and review [N/A]

On-Line Medical Evaluation

An on-line electronic medical evaluation is a non-face-to-face E/M service by a physician to a patient using Internet resources in response to a patient’s on-line inquiry. Reportable services involve the physician’s personal timely response to the patient’s inquiry and must involve permanent storage (electronic or hard copy) of the encounter. A reportable service encompasses the sum of communication (eg, related telephone calls, prescription provision, laboratory orders) pertaining to the on-line patient encounter.

99444    Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network  [N/A]

*All values are based on the 2016 National Medicare Fee Schedule for the Non-Facility Setting.

A – Active status on the Medicare fee schedule (payable)

B – Service is bundled

I – Not valid for Medicare purposes

N – Non-Covered Services

N/A – No published RVUs

Telehealth Services

The reporting of telehealth services varies by payer. At the present time, Medicare offers the only national standards, which are outlined below.

Hosting Facility

The Centers for Medicare and Medicaid Services (CMS) requires reported telehealth services to include both an originating site and a distant site. The originating site is the location of the patient at the time the service is being furnished. The distant site is the site where the physician or other licensed practitioner delivering the service is located.

A telehealth facility fee is paid to the originating site. Claims for the facility fee should be submitted using HCPCS code Q3014: “Telehealth originating site facility fee.” Originating sites include: the office of a physician or practitioner, Hospitals, Critical Access Hospitals (CAH), Rural Health Clinics (RHC), Federally Qualified Health Centers (FQHC), Hospital-based or CAH-based Renal Dialysis Centers (including satellites), Skilled Nursing Facilities (SNF), and Community Mental Health Centers.

Consulting Provider

Claims for professional services should be submitted using the appropriate service code (please table see below) and the modifier “GT” or “GQ.”

GT modifier: Providers at the distant site submit claims for telemedicine services using the appropriate CPT or HCPCS code for the professional service along with the modifier GT, “via interactive audio and video telecommunications system” (eg, G0426-GT). Appending the GT modifier with a covered procedure code indicates that the distant site physician certifies that the beneficiary was present at an eligible originating site when the service was furnished.

GQ modifier: Providers participating in the federal telemedicine demonstration programs in Alaska or Hawaii must submit the appropriate CPT or HCPCS code for the professional service along with the modifier GQ, “via asynchronous telecommunications system.”

NOTE: While Medicare contractors may require the GT or GQ modifier and do not allow CPT consultation codes, some private payers request CPT consultation codes without the Medicare modifiers. Medicaid policies also vary state to state. Since payer polices vary, you are advised to check with the local payers with which you participate regarding use of these modifiers.

The chart below provides the CY 2013 list of Medicare telehealth services

CY 2015 Medicare Telehealth Services Service     Healthcare Common Procedure Coding System (HCPCS)/CPT Code

Telehealth consultations, emergency department or initial inpatient        HCPCS codes G0425–G0427

Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs                HCPCS codes G0406–G0408

Office or other outpatient visits CPT codes 99201–99215

Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days    CPT codes 99231–99233

Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days                CPT codes 99307–99310

Individual and group kidney disease education services   HCPCS codes G0420 and G0421

Individual and group diabetes self-management training services, with a minimum of 1 hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training             HCPCS codes G0108 and G0109

Individual and group health and behavior assessment and intervention   CPT codes 96150–96154

Individual psychotherapy             CPT codes 90832–90834 and 90836–90838

Telehealth Pharmacologic Management                HCPCS code G0459

Psychiatric diagnostic interview examination       CPT codes 90791 and 90792

End-Stage Renal Disease (ESRD)-related services included in the monthly capitation payment                CPT codes 90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961

Individual and group medical nutrition therapy   HCPCS code G0270 and CPT codes 97802–97804

Neurobehavioral status examination       CPT code 96116

Smoking cessation services          HCPCS codes G0436 and G0437 and CPT codes 99406 and 99407

Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services               HCPCS codes G0396 and G0397

Annual alcohol misuse screening, 15 minutes      HCPCS code G0442

Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes   HCPCS code G0443

Annual depression screening, 15 minutes             HCPCS code G0444

High-intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes     HCPCS code G0445

Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes               HCPCS code G0446

Face-to-face behavioral counseling for obesity, 15 minutes           HCPCS code G0447

Transitional care management services with moderate medical decision complexity (face-to-face visit within 14 days of discharge)     CPT code 99495

Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge) CPT code 99496

Psychoanalysis (effective for services furnished on and after January 1, 2015)       CPT codes 90845

Family psychotherapy (without the patient present) (effective for services furnished on and after January 1, 2015)    CPT code 90846

Family psychotherapy (conjoint psychotherapy) (with patient present) (effective for services furnished on and after January 1, 2015) CPT code 90847

Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (effective for services furnished on and after January 1, 2015)    CPT code 99354

Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (effective for services furnished on and after January 1, 2015)    CPT code 99355

Annual Wellness Visit, includes a personalized prevention plan of service (PPPS) first visit (effective on and after January 1, 2015) HCPCS code G0438

Annual Wellness Visit, includes a personalized prevention plan of service (PPPS) subsequent visit (effective on and after January 1, 2015)        HCPCS code G0439

For ESRD-related services, a physician, NP, PA, or CNS must furnish at least one “hands on” visit (not telehealth) each month to examine the vascular access site.

Both Medicare and Medicaid have more information on their rules and coverage for telehealth and telemedicine services. Refer to their individual pages for more details

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