Telemedicine/Telehealth/eVisit Fact Sheet #telemedicine #telehealth #digitalhealth #medicare #CMS #hippa

Originating Site:

• Physician and practitioner offices • 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) • Community Mental Health Centers (CMHCs) • Renal Dialysis Facilities* • Homes of beneficiaries with End Stage Renal Disease (ESRD) getting home dialysis* • Mobile Stroke Units* • Home of Patient receiving treatment for SUD/Opioid Abuse and cooccurring mental health disorders* (*Geographic limit may not apply to these facilities in specific circumstances).

Distant Site:

Medicare does not provide a definition of distant site. CMS has stated that providers cannot be located out of the country when providing the service via telehealth.

Those providers include: • Physicians • Nurse practitioners (NPs) • Physician assistants (PAs) • Nurse-midwives • Clinical nurse specialists (CNSs) • Certified registered nurse anesthetists • Clinical psychologists (CPs) and clinical social workers (CSWs)5 • Registered dietitians or nutrition professionals

Place of Service:

For synchronous telehealth services in Medicare, a POS 02 must go on the bill. The POS used when the services are not synchronous is where the service took place at the time of the encounter.

Modifiers:

• G0 (zero): Used to identify telehealth services furnished for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke.

• GQ: (not used outside of Alaska or Hawaii): asynchronous telehealth service.

• GT: Critical Access Hospital distant site providers billing under CAH Optional Method II. This goes on an institutional claim and pays 80% of the Professional Fee Service rate.

• GY: Notice of Liability Not Issued, Not Required Under Payer Policy. Used to report that an Advanced Beneficiary Notice (ABN) was not issued because item or service is statutorily excluded or does not meet definition of any Medicare benefit.

• 95: Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System.

REMOTE EVALUATION AND VIRTUAL CHECK-IN

• G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store-and-forward). (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) (appx reimbursement: $12)

• G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient. (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. (appx reimbursement: $15)

(The patient must verbally consent to receive virtual check-in services. The Medicare coinsurance and deductible would apply to these services.)

REMOTE PHYSIOLOGIC MONITORING

• 99457: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month. (appx reimbursement: $52)

• 99453: Device initial set-up code which can be billed after 16 days of monitoring. (appx reimbursement: $20)

• 99454: The transmission code that should be billed at the end of each 30-day monitoring period or after monitoring has ended (if less than 30 days) based on CMS guidance on other remote monitoring services. (appx reimbursement: $64)

eCONSULT OR INTERPROFESSIONAL CONSULTATIONS

FQHCs and RHCs cannot bill for eConsult under Medicare.

• 99446-99449: Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional (5 minutes through and over 31 minutes). (appx reimbursement: $19, $38, $55, $74)

• 99451: Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time. (appx reimbursement: $36)

• 99452: Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/ requesting physician or other qualified health care professional, 30 minutes. (appx reimbursement: $38)

ONLINE DIGITAL EVALUATION SERVICE (eVISIT)

A communication between a patient and their provider through an online patient portal.

CPTs for qualified healthcare professionals who can bill E&M services.

• 99421: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 5-10 minutes. (appx reimbursement: $15)

• 99422: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11-20 minutes. (appx reimbursement: $32)

• 99423: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 21 or more minutes. (appx reimbursement: $53)

CPTs for qualified nonphysician healthcare professionals (clinical staff can be pharmacists, medical assistants, technicians, nurses, therapists) who cannot independently bill E&M services.

• 98970 (G2061 for Medicare): Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes. (appx reimbursement: $12)

• 98971 (G2062 for Medicare): Qualified nonphysician healthcare professional online assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes. (appx reimbursement: $23)

• 98972 (G2063 for Medicare): Qualified nonphysician qualified healthcare professional assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes. (appx reimbursement: $33)

MEDICARE TELEHEALTH VISITS

A visit with a provider that uses telecommunication system between a provider and a patient.

Common telehealth codes include:

• 99201-99205: New outpatient evaluation and management.

• 99211-99215: Established outpatient evaluation and management.

• G0425-G0427: Telehealth consultations, emergency department or initial inpatient.

• G0406-G0408: Follow-up inpatient telehealth consultation furnished to the beneficiaries in hospitals or SNFs.

(complete list available at: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes)

KEEP IN MIND

Medicare will pay for the telehealth services based on HRSA guidelines and it can be reviewed at https://data.hrsa.gov/tools/medicare/telehealth

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA):  Effective immediately (March 17^th, 2020), the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.  For more information:

https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

Resources:

https://www.cms.gov

https://www.aha.org

https://www.dhcs.ca.gov

https://med.noridianmedicare.com

https://www.federalregister.gov

https://searchhealthit.techtarget.com

https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-16041.pdf

https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-24086.pdf

https://www.ama-assn.org

https://www.ihs.gov

https://innovation.cms.gov

https://www.cchpca.org

#telemedicine #telehealth #digitalhealth #medicare #CMS #hippa