New CPT Codes Approved for Telehealth

CPT Codes Approved for Telehealth

In Medicare’s 2014 physician fee schedule, the Centers for Medicare and Medicaid Services outlined several new telehealth services and service regions that will be reimbursed by the federal government starting 2014.  These changes include new services for mental health providers.

CMS is expanding the geographic areas where Medicare will cover telehealth into the “the fringes of metropolitan areas,” as noted by the American Telemedicine Association (ATA).

New CPT Codes & Other Supportive Changes

According to the ATA, other substantial changes that further support telehealth include:

* Adding coverage for transitional care management services (CPT codes 99495 and 99496) and making explicit that coverage includes the Evaluation and Management portion of these services;

* Adding coverage for chronic care services (CPT codes 99487-99489) for patients with multiple chronic conditions that are expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.  These services are for a patient whose medical and/or psychosocial problems require moderate or high complexity medical decision-making during transitions in care from an inpatient hospital setting. 

Facility Fees Increase

Medicare also provides payment of a facility fee to approved originating sites.  That telehealth originating site facility fee for 2014 is increased to $24.63—up 20 cents from 2013.

Use Modifer Codes

Add modifier “GT “Interactive audio and video telecommunications systems or “GQ” Asynchronous telecommunications system to the procedure codes when billing to indicate the use of telecommunications  services.

Adding new CPT Codes

Every year, CMS solicits requests to add services to the list of Medicare telehealth services. The deadline to submit requests  is December 31 for the next rulemaking cycle. For instructions, visit www.cms.gov/telehealth.

New Website Being Built by HRSA to Aid Providers

The complexities of knowing whether or not providers are eligible for reimbursement will soon be reduced with a new website currently being built by the Health Resources Services Administration (HRSA).

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4 comments on “New CPT Codes Approved for Telehealth

    • Rebecca,

      You can use the same code as you do for in-person care, but depending on who you are billing, you can just add “-GT” after the code. Call the insurer to know exactly how they want you to bill, and whether you are eligible to bill.

      For more information, consider our 3-hour training for successful reimbursement strategies: http://telehealth.org/individual/301c/

  1. Hi, is there a specific cpt code used billing for a new patinent phone consult from a doctor who is not in the same state as you?

    • Tami,

      The doctor in question may need to get training or consultation in this matter. Billing is a bit complicated because it depends on 2 factors: the doctor’s licensure and the CPT code preferred by the insurer. For yet more details, the doctor in question may need to get professional training to be in compliance with state and federal law, as well as their professional ethical board. Such training is available here: http://telehealth.org/courses.

      1. There is no specific code for practicing over state lines because without proper registration or licensing in the foreign state, such a practice is illegal within the US. We have just given a webinar on this licensure topic and it is available on demand here: https://telehealth.org/webinar/ So the first point is that Insurance companies do not reimburse for illegal practice.
      2. Second the issue of CPT code is also complex because there is a CTP code that can be determined by the payer, and a place of service code. For those details, our reimbursement course would be the most relevant: https://telehealth.org/individual/

      To resolve any lingering questions or to get a quick answer, consultation is available here: http://telehealth.org/fees

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