Final Rule for Telehealth and Digital Services
The Centers for Medicare & Medicaid Services (CMS) issued the 2023 Physician Fee Schedule (PFS) final rule on 1st November 2022. The final rule for telehealth and digital service providers includes significant changes. Starting new codes that will impact the future growth of these areas. Moreover, medical billers and coders need to answer questions related to their digital and telehealth services. Which coders are to be used for which services? How do digital and telehealth services get reimbursed, among many other questions?
Let’s start learning about it by the CPT codes that are used for digital and telehealth services:
Medical Billing CPT Codes
- Online Digital E/M Services
These codes are used by clinicians who can bill independent online evaluation and management (E/M) services. These physicians send “messages” codes, not video, telephone, or in-person services meant for E/M Services of a type to be done face-to-face through a HIPAA-compliant secure platform. These CPT codes account for up to 7 days of the cumulative time during the seven days for an established patient for an interval of:
- 99421: 5-10 minutes
- 99424: 11–20 minutes
- 99423: 21 minutes or more
Points to Remember
- CMS needs verbal agreement.
- Through the portal, the patient submits a request for the service.
- The patient’s medical record has a note about the service.
- These codes shouldn’t be used to communicate a concern if the patient has received an E/M service.
- If the inquiry relates to a fresh issue (one that hasn’t been resolved by the E/M service in the preceding seven days), these codes may be billed.
- The time of the decision-making complexity or the online service may be utilized to select the E/M service if a face-to-face E/M service takes place within seven days of the online service’s launch. This service, however, might not be billed.
- Surgeons are not permitted to bill for this throughout the worldwide period.
- The digital service must be delivered via a HIPAA-compliant platform, such as a secure email, an electronic health record portal, or other digital applications.
- Only one of these services may be recorded every seven days.
- Time spent by clinical staff is excluded.
- Exclude any time spent on any other separately reported services, such as care management, INR monitoring, or remote monitoring.
- Online Digital without E/M Service Billing
These codes are used by clinicians in medical billing who are qualified for non-physician healthcare professionals and don’t have evolution and management (E/M) services in their practice scope. For online digital evaluation and management services, these codes in the Medicare payment schedule have a status indicator of invalid,” and no RVUs have been allocated to them. These CPT codes represent up to 7 days of total time during the following periods for a patient who has been established:
98970: 5-10 minutes
98971: 1-20 minutes
98972: 21 or more minutes
- Telehealth Visits
No of the originating site or location, telehealth visits will be reimbursed for all traditional Medicare members. A pre-existing connection with a patient is not necessary to conduct a telemedicine visit, though. Instead, Skype, FaceTime, and other widely used communication tools can be used to deliver telehealth/e-visits. As a result, you can bill telehealth appointments that are audio-only or audio-video in the same way that you would an in-person visit. These codes apply to synchronous visual/auditory evaluation and management visits for the following:
99201 – 99205 New patient office/ Outpatient E/M visit
99210 – 99215 Established Patient/ Outpatient E/M Visit
G0425 – G0427 Initial emergency department telehealth consultations for patients (Medicare only)
G0406 – GO407 For patients in hospitals or SNFs, additional inpatient consultations (Medicare only)
Modifier 95 Most commercial payers use Medicare telehealth billing companies temporarily.
- Telephone E/M Services
Evaluation and management (E/M) services provided over the phone or via audio only cannot be used to refer patients to an E/M service or procedure that will take place within the next 24 hours, be derived from an E/M service that will take place within the next 7 days, or be scheduled at the earliest convenient time. These services are temporarily covered by Medicare and some Medicaid program during the following period:
Enhance Your Reimbursements!
Beginning in January 2023, the provisions of the Final Rule will unquestionably have a significant impact on the prospects of telehealth and digital services within the Medicare Program and beyond. The rules for charging for digital and telehealth services are still being created, though. In actuality, each payer has its own requirements for charging digital and telehealth services (Medicaid, Medicare, private payers, etc.).