Article

Medicare Learning Network - Telehealth Services Fact Sheet - 2018
Services offered via telehealth and the corresponding HCPCS/CPT code to use for reimbursement. 

February 18, 2018 by Center for Medicare and Medicaid Services

TELEHEALTH SERVICES

TABLE OF CONTENTS

Originating Sites……………………………………………. 2

Distant Site Practitioners………………………….. 3

Telehealth Services…………………………………. 3

Billing and Payment for Professional Services Furnished Via Telehealth……………… 7

Billing and Payment for the Originating Site Facility Fee……………………………………………… 8

Resources……………………………………………….. 8

Helpful Websites…………………………………………… 9

Regional Office Rural Health Coordinators. 10

CPT codes, descriptions and other data only are copyright 2017American Medical Association. All Rights Reserved. Applicable FARS/HHSAR apply. CPT is a registered trademark of the American Medical Association.Applicable FARS/HHSAR Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use.

The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Learn about these calendar year (CY) 2018 Medicare telehealth services topics:

  • Originating sites
  • Distant site practitioners
  • Telehealth services
  • Billing and payment for professional services furnished via telehealth
  • Billing and payment for the originating site facility fee
  • Resources
  • Lists of helpful websites and Regional Office Rural Health Coordinators

When we use “you” in this publication, we are referring to physicians or practitioners at the distant site.

Medicare pays for a limited number of Part B services furnished by a physician or practitioner to an eligible beneficiary via a telecommunications system. For eligible telehealth services, the use of a telecommunications system substitutes for an in-person encounter.

 

ORIGINATING SITES

An originating site is the location of an eligible Medicare beneficiary at the time the service furnished via a telecommunications system occurs. Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in:

  • A county outside of a Metropolitan Statistical Area (MSA) or
  • A rural Health Professional Shortage Area (HPSA) located in a rural census tract

The Health Resources and Services Administration (HRSA) determines HPSAs, and the Census Bureau determines MSAs. You can access HRSA’s Medicare Telehealth Payment Eligibility Analyzer to determine a potential originating site’s eligibility for Medicare telehealth payment.

Entities that participate in a Federal telemedicine demonstration project approved by (or receiving funding from) the Secretary of the U.S. Department of Health & Human Services as of

December 31, 2000, qualify as originating sites regardless of geographic location.

Each CY, the geographic eligibility of an originating site is established based on the status of the area as of December 31st of the prior CY. Such eligibility continues for the full CY.

The originating sites authorized by law are:

  • The offices of physicians or practitioners
  • Hospitals
  • Critical Access Hospitals (CAHs)
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Hospital-based or CAH-based Renal Dialysis Centers (including satellites)
  • Skilled Nursing Facilities (SNFs) and
  • Community Mental Health Centers (CMHCs)

Note:    Independent Renal Dialysis Facilities are not eligible originating sites.

 

DISTANT SITE PRACTITIONERS

Practitioners at the distant site who may furnish and receive payment for covered telehealth services (subject to State law) are:

  • Physician
  • Nurse practitioners (NPs).
  • Physician assistants (PAs).
  • Nurse-midwives.
  • Clinical nurse specialists (CNSs).
  • Certified registered nurse
  • Clinical psychologists (CPs) and clinical social workers (CSWs). CPs and CSWs cannot bill for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services under Medi These practitioners may not bill or receive payment for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838.
  • Registered dietitians or nutrition

 

TELEHEALTH SERVICES

As a condition of payment, you must use an interactive audio and video telecommunications system that permits real-time communication between you, at the distant site, and the beneficiary, at the originating site. Asynchronous “store and forward” technology, the transmission of medical information the physician or practitioner at the distant site reviews at a later time, is permitted only in Federal telemedicine demonstration programs in Alaska or Hawaii.

CY 2018 Medicare Telehealth Services

 

Service 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

 

CPT only copyright 2017American Medical Association. All rights reserved.

CY 2018 Medicare Telehealth Services (cont.)

 

Service HCPCS/CPT Code
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

End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients younger than

2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents

CPT code 90963
End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents CPT code 90964
End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents CPT code 90965
End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 20 years of age and older CPT code 90966
End-Stage Renal Disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age (effective for services furnished on and after January 1, 2017) CPT code 90967

CPT only copyright 2017American Medical Association. All rights reserved.

CY 2018 Medicare Telehealth Services (cont.)

 

Service HCPCS/CPT Code
End-Stage Renal Disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients 2-11 years of age (effective for services furnished on and after January 1, 2017) CPT code 90968
End-Stage Renal Disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients 12-19 years of age (effective for services furnished on and after January 1, 2017) CPT code 90969
End-Stage Renal Disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients 20 years of age and older (effective for services furnished on and after January 1, 2017) CPT code 90970
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

CPT only copyright 2017American Medical Association. All rights reserved.

CY 2018 Medicare Telehealth Services (cont.)

Service HCPCS/CPT Code
Advance Care Planning, 30 minutes (effective for services furnished on and after January 1, 2017) CPT code 99497
Advance Care Planning, additional 30 minutes (effective for services furnished on and after January 1, 2017) CPT code 99498
Psychoanalysis CPT code 90845
Family psychotherapy (without the patient present) CPT code 90846
Family psychotherapy (conjoint psychotherapy) (with patient present) CPT code 90847
Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour CPT code 99354
Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes CPT code 99355
Prolonged service in the inpatient or observation setting requiring uniUfloor time beyond the usual service; first hour (list separately in addition to code for inpatient evaluation and management service) CPT code 99356
Prolonged service in the inpatient or observation setting requiring uniUfloor time beyond the usual service; each additional 30 minutes (list separately in addition to code for prolonged service) CPT code 99357
Annual Wellness Visit, includes a personalized prevention plan of service (PPPS) first visit HCPCS code G0438
Annual Wellness Visit, includes a personalized prevention plan of service (PPPS) subsequent visit HCPCS code G0439
Telehealth Consultation, Critical Care, initial, physicians typically spend 60 minutes communicating with the patient and providers via telehealth (effective for services furnished on and after January 1, 2017) HCPCS code G0508
Telehealth Consultation, Critical Care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth (effective for services furnished on and after January 1, 2017) HCPCS code G0509
Counseling visit to discuss need for lung cancer screening using low dose CT scan (LDCT) (service is for eligibility determination and shared decision making (effective for services furnished on and after January 1, 2018) HCPCS code G0296

CPT only copyright 2017American Medical Association. All rights reserved.

CY 2018 Medicare Telehealth Services (cont.)

 

Service HCPCS/CPT Code
Interactive Complexity Psychiatry Services and Procedures (effective for services furnished on and after January 1, 2018) CPT code 90785
Health Risk Assessment (effective for services furnished on and after January 1, 2018) CPT codes 96160 and 96161
Comprehensive assessment of and care planning for patients requiring chronic care management (effective for services furnished on and after January 1, 2018) HCPCS code G0506
Psychotherapy for crisis (effective for services furnished on and after January 1, 2018) CPT codes 90839 and 90840

 

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.

BILLING AND PAYMENT FOR PROFESSIONAL SERVICES FURNISHED VIA TELEHEALTH

Submit claims for telehealth services using the appropriate CPT or HCPCS code for the professional service.

For Federal telemedicine demonstration programs in Alaska or Hawaii, submit claims using the appropriate CPT or HCPCS code for the professional service along with the telehealth modifier GQ

if you performed telehealth services “via an asynchronous telecommunications system” (for example, 99201 GQ).By coding and billing the GQ modifier, you are certifying that the asynchronous medical file was collected and transmitted to you at the distant site from a Federal telemedicine demonstration project conducted in Alaska or Hawaii.

For professional services furnished on or after January 1, 2017, to indicate that the billed service was furnished as a telehealth service from a distant site, submit claims for telehealth services using Place of Service (POS) 02: Telehealth: The location where health services and health-related services are provided or received, through telehealth telecommunication technology.As of January 1, 2018, distant site practitioners billing telehealth services under the CAH Optional Payment Method submit institutional claims using the GT modifier.

You should bill the Medicare Administrative Contractor (MAC) for covered telehealth services. Medicare pays you the appropriate amount under the Medicare Physician Fee Schedule (PFS) for telehealth services. When you are located in a CAH and reassigned your billing rights to a CAH that elected the Optional Payment Method, the CAH bills the MAC for telehealth services, and the payment amount is 80 percent of the Medicare PFS for telehealth services.

CPT only copyright 2017American Medical Association. All rights reserved.

BILLING AND PAYMENT FOR THE ORIGINATING SITE FACILITY FEE

Originating sites are paid an originating site facility fee for telehealth services as described by HCPCS code 03014. Bill the MAC for the originating site facility fee, which is a separately billable Part B payment.

Note:    When a CMHC serves as an originating site, the originating site facility fee does not count toward the number of services used to determine payment for partial hospitalization services.

RESOURCES

Telehealth Services Resources

 

For More Information About… Resource
Telehealth Services CMS.gov/Medicare/Medicare-General-Information/ Telehealth

Chapter 12 of the Medicare Claims Processing Manual

{Publication 100-04)

Physician Bonuses CMS.gov/Medicare/Medicare-Fee-for-Service-PaymenU HPSAPSAPhysicianBonuses

Health Professional Shortage Area Physician Bonus Program

All Available MLN Products MLN Catalog
Medicare Information for Beneficiaries Medicare.9ov

 

Hyperlink Table

 

Embedded Hyperlink Complete URL
Health Professional Shortage Area https://www.cms.gov/Medicare/Medicare-Fee-for-Service- PamenUHPSAPSAPhsicianBonuses/i  ndex.html
Medicare Telehealth Payment Eligibility Analyzer https://datawarehouse.   hrsa.gov/tools/analyzers/geo/ Telehealth.aspx
Medicare Claims Processing Manual https://www.cms.gov/Regulations-and-Guidance/Guidance/ Manuals/Downloads/elm104c12.pdf
Health Professional Shortage Area Physician Bonus Program https://www.cms.gov/Outreach-and-Education/Medi  care- Learning-Network-MLN/MLNProducts/Down  loads/ HPSAfctsht.pdf
MLN Catalog https://www.cms.gov/Outreach-and-Education/Medi  care- Learning-Network-MLN/MLNProducts/Down  loads/ MLNCatalog.pdf

 

HELPFUL WEBSITES

American Hospital Association Rural Health Care

https://www.aha.org/advocacy/small-or-rural

Critical Access Hospitals Center

https://www.cms.gov/Center/Provider-Type/Critical-Access-Hospitals-Center.html

Disproportionate Share Hospitals

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcutelnpatientPPS/dsh.html

Federally Qualified Health Centers Center

https://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center    .html

Health Resources and Services Administration

https://www.hrsa.gov

HospitalCenter

https://www.cms.gov/Center/Provider-Type/Hospital-Center   .html

Medicare Learning Network®

http://go.cms.gov/MLNGenlnfo

NationalAssociation of Community Health Centers

http://www.nachc. org

NationalAssociation of Rural Health Clinics

https://narhc.org

NationalRuralHealth Association

https://www.ruralhealthweb.org

Rural Health Clinics Center

https://www.cms.gov/Center/Provider-Type/Rural-Health-Clinics-Center.html

Rural Health Information Hub

https://www.ruralhealthinfo.org

Swing Bed Providers

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/SwingBed.html

Telehealth

https://www.cms.gov/Medicare/Medicare-General-lnformati    on/Telehealth

Telehealth Resource Centers

https://www.telehealthresourcecenter.org

U.S. Census Bureau

https://www.census.gov

REGIONAL OFFICE RURAL HEALTH COORDINATORS

To find contact information for CMS Regional Office Rural Health Coordinators who provide technical, policy, and operational assistance on rural health issues, refer to CMS.gov/Outreach-and-Education/ Outreach/OpenDoorForums/Down   loads/CMSRuralHeal  thCoordinators.pdf.

 

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf

 

 

 

 

 

 

 

 

 

 

 

 

 

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