video visit cpt codes 2022

Contact | Patient Info | Foundation | AASM Engage JOIN Today   Login with CSICloud

• AASM Scoring Manual
• Artificial Intelligence
• COVID-19 Resources
• EHR Integration
• Emerging Technology
• Patient Information
• Practice Promotion Resources
• Provider Fact Sheets
• #SleepTechnology
• Telemedicine

• Annual Meeting
• Career Center
• Case Study of the Month
• Change Agents Submission Winners
• Compensation Survey
• Conference Support
• Continuing Medical Education (CME)
• Maintenance of Certification (MOC)
• State Sleep Societies
• Talking Sleep Podcast
• Young Investigators Research Forum (YIRF)

• Leadership Election
• Board Nomination Process
• Membership Directory
• Volunteer Opportunities
• International Assembly

• Accreditation News
• Accreditation Verification
• Program Changes

AASM accreditation demonstrates a sleep medicine provider’s commitment to high quality, patient-centered care through adherence to these standards.

• AASM Social Media Ambassador
• Advertising
• Affiliated Sites
• Autoscoring Certification
• Diversity, Equity and Inclusion
• Event Code of Conduct Policy
• Guiding Principles for Industry Support
• CMSS Financial Disclosure
• IEP Sponsors
• Industry Programs
• Newsletters
• Patient Advocacy Roundtable
• President’s Report
• Social Media
• Strategic Plan
• Working at AASM
• Practice Standards
• Coding and Reimbursement
• Choose Sleep
• Advanced Practice Registered Nurses and Physician Assistants (APRN PA)
• Accredited Sleep Technologist Education Program (A-STEP)
• Inter-scorer Reliability (ISR)
• Coding Education Program (A-CEP)
• Individual Member – Benefits
• Individual Member – Categories
• Members-Only Resources
• Apply for AASM Fellow
• Individual Member – FAQs
• Facility Member – Benefits
• Facility Member – FAQs
• Sleep Team Assemblies
• Types of Accreditation
• Choose AASM Accreditation
• Special Application Types
• Apply or Renew

Telemedicine Codes

Telemedicine and telehealth are used interchangeably throughout the United States healthcare system, in reference to the exchange of medical information from one site to another through electronic communication. Reporting of telemedicine/telehealth services varies by payer and state regulations.

AASM Telemedicine/Telehealth Resources

• AASM Coding FAQs
• AASM Telemedicine Video Library

CMS Telemedicine/Telehealth Codes

The codes below are commonly reported for Medicare patients:

CMS finalized the creation of two additional G codes that can be billed by practitioners who cannot independently bill for E/M services. G2250 and G2251 are billable by certain non-physician practitioners, consistent with the scope of these practitioners’ benefit categories.

CPT Telemedicine Codes

Modifier 95 indicates a synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. The 2020 CPT® manual includes Appendix P, which lists a summary of CPT codes that may be used for reporting synchronous (real-time) telemedicine services when appended by modifier 95. Procedures on this list involve electronic communication using interactive telecommunications equipment that includes, at a minimum, audio and video.

HCPCS LEVEL II CODES

There are also HCPCS Level II codes that describe telemedicine services.

Place of Service (POS) Code for Telemedicine

On January 1, 2017 the Center for Medicare and Medicaid Services (CMS) introduced place of service (POS) code 02 to identify telemedicine services. The descriptor for POS code 02 is “The location where health services and health related services are provided or received, through telecommunication technology.” Use of the telehealth POS code certifies that the service meets all of the telehealth requirements. Many private payers have also begun requiring use of POS code 02 for telemedicine services.

GT/GQ Modifiers

Medicare previously required providers to submit claims for telehealth services using the appropriate procedure code along with the telehealth GT modifier (“via interactive audio and video telecommunications systems”) or GQ modifier (“via an asynchronous (delayed communications) telecommunications system”). As of January 1, 2018, the GT modifier is only allowed on institutional claims billed under Critical Access Hospital (CAH) Method II since institutional claims do not use a POS code. If the GT modifier is billed by other provider types, the claim line will be rejected. The GQ modifier is still required when applicable (e.g., for those providers participating in the Alaska or Hawaii federal telemedicine demonstration programs).

Additional CMS Telemedicine/Telehealth Resources

• Complete list of CMS Telehealth Services
• General Provider Telehealth and Telemedicine Toolkit
• Medicare Telehealth Frequently Asked Questions (FAQs)
• Medicare Telehealth Services

Note: CPT Copyright 2021 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.

An official website of the United States government

The .gov means it’s official. A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Billing and coding Medicare Fee-for-Service claims

Read the latest guidance on billing and coding Medicare Fee-for-Service (FFS) telehealth claims.

On this page:

Telehealth codes covered by medicare, coding claims, common telehealth billing mistakes, more information about ffs billing.

Medicare added over one hundred CPT and HCPCS codes to the list of telehealth services .

Telephone visits and audio-only telehealth

Medicare is temporarily waiving the audio-video requirement for many telehealth services. Codes that have audio-only waivers are noted in the list of telehealth services .

Place of Service codes

When billing telehealth claims, it is important to understand the place of service (POS) codes as it affects reimbursement.

The POS code (PDF) explains where the provider and patient are located during the telehealth encounter. There are currently two POS codes:

• POS 02: Telehealth provided other than in patient's home. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
• POS 10: Telehealth provided in patient's home. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.

Avoiding mistakes in the reimbursement process can help implementing telehealth into your practice a smoother experience.

Incorrect billing codes

More than 100 telehealth services are covered under Medicare. However, some CPT and HCPCS codes are only covered temporarily.

Using the wrong code can delay your reimbursement. This can happen for a variety of reasons, such as a misunderstanding of what code applies to what service or input error.

Stay up to date on the latest Medicare billing codes  for telehealth to keep your practice running smoothly.

Documentation

Post-visit documentation must be as thorough as possible to ensure prompt reimbursement.

While there are many similarities between documenting in-person visits and telehealth visits, there are some key factors to keep in mind.

Patient consent

Make a note of whether the patient gave you verbal or written consent to conduct a virtual appointment.

Code categories

Telephone codes are required for audio-only appointments, while office codes are for audio and video visits.

Time of visit

A common mistake made by health care providers is billing time a patient spent with clinical staff. Providers should only bill for the time that they spent with the patient.

Store-and-forward

Many states require telehealth services to be delivered in “real-time”, which means that store-and-forward activities are unlikely to be reimbursed. You can find information about store-and-forward rules in your state here  .

Originating sites and distant sites

Learn about eligible sites as well as telehealth policies specific to Federally Qualified Health Centers and Rural Health Clinics.

If you are looking for detailed guidance on what is covered and how to bill Medicare FFS claims, see:

• Billing for Telehealth Encounters: An Introductory Guide on Fee-for-Service  (PDF) – from the National Policy Center - Center for Connected Health Policy

Medicaid and Medicare billing for asynchronous telehealth

Learn how to bill for asynchronous telehealth, often called “store and forward".

Billing Medicare as a safety-net provider

Medicare billing and coding guidelines on telehealth for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).

LIVE CME or CE e-Learning Activity: Navigating PSYPACT: Your Guide to Interstate Practice See Details

Cultural Diversity & Social Justice Training: How to Offer Culturally-Competent Care See Details

Telehealth Reimbursement Alert: Federal Register Releases Allowed 2022 Telehealth CPT Codes & Services

MARLENE MAHEU, PhD

UPDATED 11/9/21 Many long-awaited decisions regarding telehealth CPT codes were released earlier this week, signaling a new frontier for telehealth reimbursement. Federal policy changes of this magnitude directly change Medicare and federal Medicaid programs, and more broadly, put direct pressure on third-party carriers to follow suit. In the unpublished version of the 2022 Physician Fee Schedule final rule, the Centers for Medicare and Medicaid Services (CMS) announced landmark changes in support of telehealth, and particularly, telebehavioral health, but only for specified conditions.  The entire document will reportedly be available on November 19, 2021.

CMS Administrator Chiquita Brooks-LaSure announced the changes by stating, “Promoting health equity, ensuring more people have access to comprehensive care, and providing innovative solutions to address our health system challenges are at the core of what we do at CMS,” She continued, “The Physician Fee Schedule final rule advances all these strategic priorities and helps build a better Medicare program for the future.”

Key points for behavioral clinicians include:

• In line with much legislation enacted last year to deliver immediate assistance to millions of U.S. citizens due to the COVID pandemic, CMS eliminated geographic barriers and allows patients at home to access telehealth services for diagnosis, evaluation, and treatment of specified conditions mental health disorders.
• The requirement for a “non-telehealth visit must be furnished at least every 12 months for these services.” They also stipulated that “exceptions to the in-person visit requirement may be made based on beneficiary circumstances (with the reason documented in the patient’s medical record).”
• Services added to the Medicare telehealth services list will remain on the list through December 31, 2023, to allow additional time for CMS to evaluate whether the services should be permanently added to the Medicare telehealth services list.
• In yet another document, as of September 2021, CME has issued a new set of CPT code modifiers, two of which are relevant to telehealth CPT code billing. Medicare telehealth services practitioners use “02” if the telehealth service is delivered anywhere except for the patient’s home. If the patient is in their home, use “10”. For telehealth, the 95 modifier code is used as well. For details, see the CMS document titled   Place of Service Codes for Professional Claims Database (updated September 2021).

In the sections below, direct quotes are taken from the unpublished version of the 2022 Physician Fee Schedule made available for public inspection before the official publication date in the Federal Register.

Audio-Only Telephone Care

The New CMS ruling allows payment for telephone sessions for mental and behavioral health services to treat substance use disorders and services provided through opioid treatment programs. Direct wording from the unpublished version of the 2022 Physician Fee Schedule made available for public inspection is provided below. (Page numbers are not provided in the original document.)

After consideration of public comments, we are finalizing as proposed creation of a service-level modifier for use to identify mental health telehealth services furnished to a beneficiary in their home using audio-only communications technology. We are also amending our regulation at § 410.78(a)(3) to specify that an interactive telecommunications system can include i nteractive, real-time, two-way audio-only technology for telehealth services furnished for the diagnosis, evaluation, or treatment of a mental health disorder as described under paragraph (b)(4)(iv)(D), under the following conditions: the patient is located in their home at the time of service as described at § 410.78 (b)(3)(xiv); the distant site physician or practitioner has the technical capability at the time of the service to use an interactive telecommunications system that includes video; and the patient is not capable of, or does not consent to, the use of video technology for the service.

We are also clarifying that SUD services are considered mental health services for purposes of the amended definition of “interactive telecommunications system” to include audio-only services under § 410.78(a)(3). We anticipate that this will positively impact access to care for mental health conditions and contribute to overall health equity. [Emphasis added by Telehealth.org]

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) – Telecommunications Technology

Mental health sessions furnished through Rural Health Clinics and Federally Qualified Health Centers via telecommunications technology, including telephone calls, will also be covered. As outlined by CMS, this provision intends to continue expanding access to vulnerable populations, including those in rural areas.

1. Revising the Definition of an RHC and FQHC Mental Health Visit a. Payment Rules for RHC and FQHC Visits and Medicare Telehealth Services Section 1861(aa)(1) of the Act defines RHC services as physicians’ services and such services and supplies that are furnished as an incident to a physician’s professional service, and items and services, as well as certain vaccines and their administration. It also includes services furnished by a PA, NP, clinical psychologist, or clinical social worker and services and supplies furnished as an incident to these services as would otherwise be covered if furnished by a physician or incident to a physician’s service. In the case of an RHC in an area with a home health agency shortage, part-time or intermittent nursing care and related medical supplies may be furnished by a registered professional nurse or licensed practical nurse to a homebound individual under certain conditions. Section 1861(aa)(3) of the Act defines FQHC services to include the specified RHC services and preventive services, as well as required primary preventive health services.

Depression Screening and Referrals from RHCs and FQHCs: Mental Health Counselors Included, Too!

Under section D.18 Preventive Care and Screening: Screening for Depression and Follow-Up Plan in the Physician Fee Schedule, the following section describes the use of non-physicians to offer “follow-up services” after patients are screened by primary care physicians in RHCs & FQHCs. It is worthy of note mental health counselors are included, whereas they have been previously excluded.

Follow-Up Plan: The follow-up plan must be related to a positive depression screening, for example: “Patient referred for psychiatric evaluation due to positive depression screening.” Examples of a follow-up plan include but are not limited to: * Referral to a practitioner or program for further evaluation for depression, for example, referral to a psychiatrist, psychologists, social workers, mental health counselors, or other mental health services such as Family or group therapy, support group, depression management program, or other services for the treatment of depression * [Emphasis added by Telehealth.org]

Other interventions designed to treat depression such as behavioral health evaluation, psychotherapy, pharmacological interventions, or additional treatment options Should a patient screen positive for depression: * A clinician should only order pharmacological intervention when appropriate and after sufficient diagnostic evaluation. However, for the purposes of this measure, additional screening and assessment during the qualifying encounter will not qualify as a follow-up plan. * A clinician should complete a suicide risk assessment when appropriate and based on individual patient characteristics. However, for the purposes of this measure, a suicide risk assessment or additional screening using a standardized tool will not qualify as a follow-up plan. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM. For the CMS Web Interface Measure Specifications collection type: A depression screen is completed on the date of the encounter or up to 14 days before the date of the encounter using an age-appropriate standardized depression screening tool, AND if positive, a follow-up plan must be documented on the date of the encounter, such as referral to a provider for additional evaluation, pharmacological interventions, or other interventions for the treatment of depression

Physician Repercussions of New CME Rulings

Dealing a blow to physicians, the conversion factor per relative value unit under the 2022 fee schedule will be reduced to $33.59, down from $34.89 in 2021, a drop of $1.31. The AMA has been quick to respond, stating, The AMA is strongly advocating for Congress to avert this and other looming cuts to Medicare physician payments that, overall, will produce a combined 9.75 percent cut for 2022. 

Why Are the Federal Register Releases & Physician Fee Schedules of Relevance to Telebehavioral Health Professionals?

The Federal Register is the daily journal of the United States government and the official dissemination channel for any changes related to CPT codes by CMS. Working closely with various stakeholders such as the American Medical Association, the American Psychological Association, and other national professional associations, the Centers for Medicare & Medicaid and Services (CMS) proposes new telehealth CPT codes every year. The proposed codes are open for comment from all stakeholders for a few weeks, the comment period is closed, and new codes are published in the Federal Register in November. They take effect on January 1 of the following year. This process is an attempt to update payment policies, payment rates, and other provisions for services. While third-party carriers differ in payment rates by state, Medicare payments for the same code can vary by zip code.

What about Private Payers?

Typically, 3rd party or private insurance carriers in the United States are given the discretion to decide which telehealth CPT codes to reimburse and at which rate. Employers and consumers seeking telehealth reimbursement for 2020 would do well to speak with their carriers before next year to negotiate plans and make informed choices about insurance plans. A third-party carrier can deny procedures reimbursed by Medicare and are, frankly, often are excluded. In most states, private insurers slowly adopted the approved CPT codes, but they are not usually required by state law to follow suit in many states. However, with the tsunami created by COVID, in some states such as California and New York, telehealth laws were recently updated with much more enforcement and penalties for noncompliance imposed by the state insurance commissioner in each state. In short, more states are requiring telehealth reimbursement. Clinicians wishing to continue offering telehealth services then are encouraged to contact their state insurance commissioner’s office as well as their state and national professional associations for more information about local regulations requiring telehealth reimbursement for the future.

Other Telehealth.org Articles of Relevance

For billable CPT codes, see Telehealth.org’s previous articles related to telehealth CPT codes below.

• RPM CPT Codes
• CMS Congressional Report: 85.4% of all Telehealth Providers Used Mental Health CPT Codes
• Future of Telehealth Reimbursement: Offering Medicare Telehealth Services?
• Counselors and marriage and Family Therapists may want to speak with the governmental staff of their national professional associations for updates on the issues discussed in Telehealth.org’s Medicare Telehealth Reimbursement: Act Introduced to Allow Counselors to be Reimbursed by Medicare for updates to the Mental Health Access Improvement Act .

BCTP®-III Telehealth Training & Certificate

Join the elite professionals who have immersed themselves in the depths of telehealth training, obtained monthly group consultation to tailor their learning to their needs, and earned the coveted BCTP®-III distinction!

Accepting Telehealth Jobs: 5 Big Legal & Ethical Mistakes to Avoid

Do you have questions about being employed or looking for employment from a digital health company? Online employment can pose dilemmas that leave clinicians at a loss for how to proceed. This program will answer your questions about how or reasonably uphold your legal and ethical mandates.

Mastering Telehealth Billing Guidelines 2024: A Blueprint for Success

In this comprehensive 1.5-hour program, you’ll navigate the evolving landscape of telehealth billing, ensuring you stay updated on essential topics like CPT and modifier codes, Medicare reimbursement, digital therapeutics, and more.

Disclaimer: Telehealth.org’s content is educational and not a substitute for legal, ethical, or clinical advice. Please exercise due diligence before making decisions. Our views do not intend to offend any organization, company, or individual. Trademark mentions imply no endorsement. Some content is ChatGPT-assisted. Links to external sites are for extra information; we’re not responsible for their content or accuracy, and our privacy policy does not extend to them. Using this site constitutes your agreement to Telehealth.org our Privacy Policy and Terms and Conditions .

Please share your thoughts in the comment box below.

I’m not sure I fully understand. Who is being left out of the new rules? And which Medicare clients won’t be able to receive telehealth services? My reading of the rules is that telehealth will be able to continue.

Jeremy, Thank you for commenting. We have revised our comments to make them clearer and also added the November 1, 2021 CMS list of approved CPT codes and associated services. If you download the file, you will see a number of behavioral codes that were approved for the COVID pandemic and several others that have been approved over the years. Let us know if you have any other questions.

Licensed Counselors and Marriage and Family Therapists have the same education requirements as the Licensed Clinical Social Workers so it is not sensible to fund one and not all three. Social workers have always have a strong lobby so have been funded. Many people will be deprived of needed services if Licensed Counselors and Marriage and Family Therapists are not also recognized. If concern is really about helping those that need behavioral health services, this is defeating the goal.

Dale Marie, Thank you for your comment. This battle is not new. A political battle has been waging for decades over whether or not counselors and MFTs can be reimbursed for serving Medicare beneficiaries. In this article, we discuss one of the more recent legislative efforts is being waged to reimburse these groups of providers, but we’ve not seen any updates as recently as Friday when we last checked: Medicare Telehealth Reimbursement: Act Introduced to Allow Counselors to be Reimbursed by Medicare If and when anyone gets news about a change in policy, please take 5 minutes to post it here for us all to see.

Great, thank you for the clarification. This is not true for me, as I am a psychologist in a FQHC, but are these new rules suggesting that licensed mental health counselors in FQHC’s are not able to bill for telephone services?

Is it once per calendar year for in person visits? I also read each telehealth visit had to be within 6 months of an in-person visit which means all patients need to be immediately seen in person before any further psychiatric telehealth is permitted. Since I see patients every 3 months when stabilized for psych meds, I essentially need to see them in person every other visit if that is true. Do you have further information regarding this? Also any rules about the providers working from home for telehealth?

Laura, Thank you for your questions. The Federal Register is the official US federal government dissemination channel for updates. We are consultants, trainers & publishers and not billing specialists. We disseminate the news that we find. However, many people would agree that official policy announcements from the Federal Register supersede previous rulings. You may want to have your billing agent research this to get confirmation from CMS. As for working from home, traditional telemedicine has been practiced by clinicians working from their homes for decades. In fact, that’s one of the big draws for the industry since day 1. The patient’s location has been the issue, not the practitioner’s. There are a few rules, such as the fact that the clinician working from home must live in an approved jurisdiction. It involves state licensing law and not federal CME reimbursement requirements. As the years wore on, some states such as Alaska started requiring providers to be in Alaska when serving Alaskans, but most states haven’t gone that far. You may also want to know that there are several other key stipulations that are wise to fully understand. See this 1-hour webinar devoted to this topic: Telehealth Working from Home: Legal & Ethical Compliance

Lmhc’s have a higher education requirement than Social Workers. We are not coordinators like LICSW but we do it. We are clinically qualified to tx. Mental Health and substance abuse clients

Anyone who believes that LMHC’s have a higher education requirement than LCSW’s NEED to do some due diligence before making statements. LICSW’s do have extensive education and it is within our scope of practice to treat substance abuse clients (noting CEU’s) In fact, historically LCSW’s were the only ones to receive reimbursement from insurance companies like psychologists and md’s. To be clear, An LMHC focuses SOLELYon a patient’s mental health (that may be changing in some schools as CARF is demanding some of the changes), whereas an LCSW helps clients with their mental health and other areas of their lives. LCSWs also work on finding ways to change an individual’s environment to adapt to their needs. They take Holistic Approaches when working with clients and try to connect clients with resources to help them reach their goals. LMHCs take a more Individualistic approach to improve development problems interfering with a client’s wellbeing. And we know what the research says… Holistic Approaches are what is efficaticacious over the long term.

Can you please suggest who I can contact regarding, “exceptions to the in-person visit requirement may be made based on beneficiary circumstances (with the reason documented in the patient’s medical record).” I see clients virtually in 3 states where I am licensed. Normally I’m told to submit claims to the BCBS or Medicare jurisdiction in the state where my practice has an address (only one state) regardless of client location. If I fly to go see a client in their state, I’m supposed to bill the BCBS or local Medicare jurisdiction for that state, where I don’t have in-network contracts, nor a practice address, and it would be processed as out of network. I know there are ways to get an address in another state, but if I do not have to spend more money on such a thing, I won’t. There then might be income tax problems when physically providing for and billing a service when I’m physically in another state.

William, Thank you for your question. I wish I had a better answer but all I can say is to contact the payer in all such specific billing questions. If the payor is Medicare or Medicaid, you may want to consider meditating a bit before jumping on the call. 🙁 Perhaps someone else reading this article has a better answer for William?

With regard to Tricare billing, when I called them today (1.4.2022) the rep said to keep using POS 11, not 10 if client is in their home. Does anyone have any info about when this will actually be effective?

Hello Lisa, In another announcement that TBHI Telehealth.org reported on November 23, CMS announced that “The change in the telehealth policy will take effect on January 1, 2022, and be implemented on April 4, 2022.” How that applied to Tricare, we don’t know. See our full announcement summary here:

To comment on the retort from the LICSW regarding LMHC’s get your facts straight. I have 24 more credits than any LICSW course of study from any school in the US which I needed to graduate and sit for my licensure exam. We both do the same job. In some States we can work in schools but in no States can we get paid for MEdicare clients. I believe both occupations are excellent with all groups they service.

“In yet another document, as of September 2021, CME has issued a new set of CPT code modifiers, two of which are relevant to telehealth CPT code billing. Medicare telehealth services practitioners use “02” if the telehealth service is delivered anywhere except for the patient’s home. If the patient is in their home, use “10”. For telehealth, the 95 modifier code is used as well“ 02 and 10 are place of service codes, which are entered on the Place of Service field of the claim line to indicate where the service was provided. They are not modifiers (which are placed after a HCPCS/CPT code).

Alec, you are correct. Thank you for taking the time to comment. This change in requirements was announced in one of our earlier articles and will take place in April of this year.

Register for Free

Telehealth.org Services

Advertisement

Most Popular Blog Topics

Coding Scenario: Coding for Virtual-Digital Visits

Virtual/Digital Visits

Note: These tables are informational, not advisory. The AAFP recommends that physicians verify each payer's policy and ask patients to verify their coverage ahead of appointments.

How do I code an e-visit (CPT 99421-99423) for a new or established patient for COVID-19-related or non-COVID-19-related care?

How do i code a virtual check-in (hcpcs codes g2012 and g2010) for a new or established patient for covid19-related or non-covid-19-related care, virtual/digital scenario notes.

Beginning March 1 and for the duration of the public health emergency, patient consent may be obtained either before or at the time of service.

Virtual check-ins and e-visits must technically be initiated by a patient; however, physicians and other providers may need to educate beneficiaries on the availability of the service prior to patient initiation.

As noted above, most payers are waiving cost-sharing for virtual check-ins and e-visits. Physicians may elect to waive cost-sharing for Medicare beneficiaries. However, Medicare will not cover the beneficiary’s cost-sharing and the service will be paid as usual.

There are no COVID-19-specific POS or modifier requirements for virtual check-ins or e-visits. Use the POS used for typical services.

COVID-19-related services should be assigned the appropriate COVID-19 ICD-10 diagnosis code. Coding guidance can be found on the CDC website . Cost-sharing waivers may not be applied to claims that do not include an appropriate COVID-19 ICD-10 diagnosis code.

Self-funded plans can develop their own policies and may opt out of some cost-sharing waivers. Similarly, Medicaid policies are established at the state-level. The AAFP recommends reaching out to your provider relations representatives or Medicare Administrative Contractors (MACs) to verify policies. The Center for Connected Health Policy is tracking COVID-19 Related State Actions .

Virtual Check-in (HCPCS Code G2012)

These are brief (5-10 minutes) conversations with a physician or other clinician to determine if an in-person visit is necessary.

The communication cannot be related to a medical visit within the previous seven days and cannot lead to medical visit within the next 24 hours (or soonest appointment available).

Physician or other clinician may respond to patient by telephone, audio/video, secure text messaging, email, or patient portal.

HCPCS code G2010 can be used when a captured video or image (store and forward) is sent to the physician. The physician must follow up with the patient within 24 business hours. The consultation must not originate from an evaluation and management (E/M) service provided within the previous seven days or lead to an E/M service within the next 24 hours (or soonest available appointment).

Medicare E-Visits (online digital evaluation and management services)

These are non-face-to-face, patient-initiated communications with the physician through an online patient portal. The communications can occur over a seven-day period, and the exchange must be stored permanently.

They are a time-based code. Physicians use the cumulative time for up to seven days to determine the level of service.

• Cumulative time includes review of the initial inquiry, review of patient records pertinent to the assessment of the patient’s problem, personal interaction with clinical staff focused on the patient’s problem, development of management plans (including generation of prescriptions or ordering of tests), and subsequent communication with the patient. Communication can occur through online, telephone, email, or other digitally supported communication

Physicians and other clinicians who may independently bill Medicare for E/M services can use the following codes.

• 99421: Online digital evaluation and management service, for a patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
• 99422: Online digital evaluation and management service, for a patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
• 99423: Online digital evaluation and management service, for a patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

E-visits should not be billed on the same day the physician reports an office visit E/M service (CPT codes 99201-99205 and 99211-99215) for the same patient. Additionally, e-visits should not be billed when using the following codes for the same communication:

• 99339-99340
• 99374-99380
• 99487 and 99489
• 99495-99466

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)

FQHCs and RHCs can bill for Virtual Communication Services using Healthcare Common Procedure Coding System (HCPCS) code G0071. Virtual communication services include:

• 5 or more minutes of virtual (non-face-to-face) communication between an FQHC or RHC practitioner and FQHC or RHC patient; or
• 5 or more minutes of remote evaluation of recorded video and/or images by an FQHC or RHC practitioner, occurring in lieu of an office visit; or
• online digital evaluation and management services for a patient, for up to 7 days, cumulative time during the seven days (5-10 minutes, 11-20 minutes, or 21 or more minutes).

These services can be provided to both new and established patients. They must be patient-initiated, and consent must be obtained before or at the time of service. The payment rate for G0071 is $24.76.

  Also in This Section

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

• Become a Member
• Everyday Coding Q&A
• Can I get paid
• Coding Guides
• Quick Reference Sheets
• E/M Services
• How Physician Services Are Paid
• Prevention & Screening
• Care Management & Remote Monitoring
• Surgery, Modifiers & Global
• Diagnosis Coding
• New & Newsworthy
• Practice Management
• E/M Rules Archive

April 27, 2024

Coding Telehealth Visits: Place of Service

Information in this article was updated July 2023, based on the 2024 Proposed Physician Fee Schedule Rule.

Coding telehealth visits changes faster than the weather here in New England. The resources on the site relate to Medicare policy and CPT codes and rules. Unfortunately, they don’t address individual commercial payer policies.

• There are two new POS codes for coding telehealth visits, but don’t start using them for Medicare.
• Place of service codes determine if the encounter is paid at the facility or non-facility rate. The non-facility rate is a higher rate of reimbursemnet.
• Congress passed a law 12/20/2020 that allows behavioral health services to continue to be billed via telehealth after the end of the public health emergency.
• The Consolidated Appropriates Act, 2023 extended certain telehealth flexibilities through Dec. 31, 2024. These are described in another article on CodingIntel.

CMS is proposing that beginning in CY 024, claims submitted with POS 10 will be paid at the higher, non-facility rate.

Beginning January 1, 2024, claims submitted with POS 02 will be pad at the lower, facility rate.

POS 02 : Telehealth Provided Other than in Patient’s Home

Description: The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.  (Effective January 1, 2017) (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.)

POS 10: Telehealth Provided in Patient’s Home

Description: The location where health services and health related services are provided or received, through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.)

See CMS’s MedLearn Matters article describing the new POS code. It seems to indicate we shouldn’t use it!  Here is what they say:

“ Medicare hasn’t identified a need for new POS code 10. Our MACs will instruct their providers to continue to use the Medicare billing instructions for Telehealth claims in Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 190 .”

This policy is confirmed in the 2023  Physician Fee Schedule Final Rule.

“As such, we are finalizing that we will continue to allow for payment be made for Medicare telehealth services at the place of service for telehealth services that ordinarily would have been paid under the PFS, if the services were furnished in-person, through the latter of the end of the of CY 2023 or the end of the calendar year in which the PHE ends. For those services furnished in a facility as an originating site, POS 02 may be used, and the corresponding facility fee can be billed, per pre-PHE policy, beginning the 152nd day after the end of the PHE.” page 197

Continue to use the place of service in which the service would have been provided until Dec. 31, 2024.

What about a patient in their car? 

From the 2023 Final Rule, p. 193. “ We remind readers that we defined “home” in our CY 2022 PFS final rule (86 FR 65059)to include, as: “both in general and for this purpose, a beneficiary’s home can include temporary lodging, such as hotels and homeless shelters. We also clarified that for circumstances where the patient, for privacy or other personal reasons, chooses to travel a short distance from the exact home location during a telehealth service, the service is still considered to be furnished ‘in the home of an individual’ for purposes of section 1834(m)(4)(C)(ii)(X) of the Act.”

Use POS 10 in this situation.

POS “10” – Telehealth Provided in Patient’s Home

One MAC, NGS posted a question about this, which is linked below.

https://www.ngsmedicare.com/web/ngs/news-article-details?lob=96664&state=97224&rgion=93623&selectedArticleId=3794814

And, here is a link to the Family Practice Management journal article that describes the policies of two other payers.

Coding telehealth visits

• Telemedicine and COVID-19 FAQ
• Telemedicine in RHCs and FQHCs
• Is it or isn’t it a telehealth service
• Telemedicine | Webinar
• Payment for telephone calls
• Overview of Medicare telehealth services
• Interprofessional Internet Consultations
• CPT® codes (99421-99423) – and payment for – online digital evaluation and management (E/M) services
• Virtual communication: two new HCPCS codes G2010 and G2012
• Should we begin using the new CPT modifier -93
• Modifier 95
• Modifier CS
• Medicare changes telehealth rules, again

Telehealth source documents you can download

• CMS list of telehealth
• AMA coding advice
• CMS interim rule – March 30, 2020
• CMS interim rule – April 30, 2020
• CMS enrollment COVID-19PEHotline
• Aledade guide to getting started with telehealth

Get Unlimited Access to CodingIntel’s Online Library

Are you a coder, biller, administrator, office manager or physician?

Learn more about the benefits of a CodingIntel membership

click here!

Last revised April 8, 2024 - Betsy Nicoletti Tags: telehealth

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

All content on CodingIntel is copyright protected. Any resource shared within the permissions granted here may not be altered in any way, and should retain all copyright information and logos.

• What is CodingIntel
• Terms of Use
• Privacy Policy

Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions.

Copyright © 2024, CodingIntel A division of Medical Practice Consulting, LLC Privacy Policy

• Log In Username Enter your ACP Online username. Password Enter the password that accompanies your username. Remember me Forget your username or password ?
• Privacy Policy
• Career Connection
• Member Forums

© Copyright 2024 American College of Physicians, Inc. All Rights Reserved. 190 North Independence Mall West, Philadelphia, PA 19106-1572 800-ACP-1915 (800-227-1915) or 215-351-2600

If you are unable to login, please try clearing your cookies . We apologize for the inconvenience.

Telephone Visits Billing, Coding and Regulations Information

Some patients may not be able to have video visits because they don’t have access to interactive audio-video technology, they may not be facile with technology, or they may just prefer not to use video technology. Practices can use audio-only telephone calls to provide care to their patients if video visits are not possible. 

• For the duration of the public health emergency, CMS and some private payers are allowing audio-only telephone calls to be billed in the same way as in-person visits and these visits will be paid in equivalent amounts as E&M codes 99212-99214. This change is effective April 30, 2020, and is retroactive to March 1, 2020. The following criteria apply to Medicare visits during the emergency. 
• Can be used for new or established patients. 
• Document verbal consent and why in-person or audio-video encounter was not possible 

Billing and Coding 

• Use modifier -93 for the reporting of medical services that are provided via real-time interaction between the physician or other qualified health care professional (QHP) and a patient through audio-only technology. The totality of the communication of information exchanged during the course of the service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. This modifier is effective January 1, 2022. 
• Use the normal Place of Service, e.g. POS = 11 for private practice. 
• ​99441​ - Medical discussion of 5 to 10 minute duration
• 99442​ - Medical discussion of 11 to 20 minute duration
• 99443​ - Medical discussion of 21 to 30 minute duration

2024 Telehealth CPT Codes: Cheat Sheet

Charika Wilcox-Lee, VP, Revenue Cycle Management

Keeping track of telehealth reimbursements accurately directly impacts your healthcare organization’s bottom line. We’ve compiled a list of telehealth CPT codes to help you better navigate telehealth billing for your care program.

Source: American Academy of Sleep Medicine (AASM)

CMS Telehealth & RPM Billing Guidelines [PDF]

In recent years, the Centers for Medicare & Medicaid Services (CMS) have released the physician fee schedule with expanded reimbursement for remote patient monitoring (RPM). The guidelines notably increase reimbursement for other services like remote therapeutic care and chronic care management, while making slight adjustments to allowances for RPM.

Top 4 Common Telehealth Billing Mistakes—And How to Avoid Them

The surge of telehealth adoption in recent years has led to regulatory changes and telemedicine coverage expansion that greatly benefits healthcare providers—if reimbursement is done correctly. Here are the top four common mistakes when billing for telehealth, and how you can avoid them.

Mistake #1: Not keeping up with the correct billing codes

As Medicare regulations change in response to public healthcare needs, the billing codes that you’re already familiar with could change as well. Submitting claims with the wrong code could result in delayed reimbursement and in some worst cases, be flagged for abuse.

Avoid by : Staying up to date with additions or deletions to the list of Medicare telehealth services .

Mistake #2: Not maintaining post-visit documentation

Ensuring that you document the right information during telehealth visits is key to getting prompt payment. For a start, touch base with your administrative team to understand the type of information you should be keeping a record of.

Avoid by : Creating a checklist that you can go over before the telehealth visit for cross-checking purposes.

Mistake #3: Not training your team on telehealth billing processes

Your team already has to keep track of thousands of CPT codes on a daily basis. With the new batch of telehealth CPT codes added to the mix, things can easily get very complicated for your team.

Avoid by : Training your team on the types of codes, processes, and all things reimbursement.

Mistake #4: Not checking with the patient’s insurance beforehand

While most major private payers provide coverage for telemedicine, it’s prudent to call up the payer and confirm if the services offered are covered. The good news is, that you’ll only need to verify this once for that particular policy.

Avoid by : Being more diligent about checking insurance coverage before the patient’s first telehealth visit. Use an insurance verification form to log the call and make sure you’re asking the right questions.

8 Key Updates to Telehealth Reimbursement in 2024

CMS has   released its final rule   for Medicare payments under the Physician Fee Schedule (PFS), introducing significant changes that will impact healthcare providers across the country. To help you stay informed and prepared, we've compiled the eight key updates you need to know.

Telehealth Reimbursement Resources & Expert Support

At Health Recovery Solutions, we provide a host of resources on reimbursement and telehealth billing modeled after best practices that we established from working with our healthcare partners—and we’re ready to help. Whether you're in the early stages of researching the benefits of telehealth and remote patient monitoring for your patients or you have an existing program in place and you're considering options to maximize the value of RPM, our team of experts is here to support you. 

Telehealth Coding Billing CPT codes for Video, Virtual and e-visit

Types of virtual services.

• Medicare telehealth visit
• virtual check-ins 

Telehealth Coding Billing CPT codes for Video, Virtual, and e-visit

Telehealth visits, virtual check-ins, post a comment.

Webmaster reserves the rights to edit/remove comments that is found irrelevant, offensive, contain profanity, serves as spam or attempts to harbor irrelevant links. Please read our Comments Policy for details.

Telemedicine CPT Codes and Billing: A Detailed Guide

Telemedicine and telehealth are two terms that people often use interchangeably. Telehealth is more concerned with the exchange of medical data from one source to the other through some form of electronic communication interface.

On the other hand, telemedicine is more related to providing the practice of medicine remotely with the help of technology.

These are somewhat similar, yet some people believe that each practice carters to a specific type of service. This is not the case, as both of these terms are broad and encompass different types of services.

Types of Digital Services

There are three types of digital or virtual services. Physicians and other healthcare providers offer Medicare patients and beneficiaries any of the three services.

These services include Medicare telemedicine visits, E-visits, and virtual checkups. Each of them encompass different definitions and complies with different CPT codes. They also carry a varied patient relationship with the provider.

Related: Complete guide on starting a telemedicine business

Billing and Documenting Telemedicine Codes

The year 2020 presented one of the unprecedented times that people had ever witnessed. One of the very interesting healthcare innovations that came out of this time was the introduction of telehealth codes. In the midst of the covid-19 uncertainties, people had to scramble in chaos when it came to receiving healthcare.

Your board and payers are the ones that will give you the most important rules that apply specifically to you and your situation. The telemedicine codes are not new, and they have existed for a long time.

Telephonic Codes

The first set of codes includes the telephonic codes. They dictate what you can do and your billing process when interacting with the patient over the phone. Some medical coverage will not include this set of codes. This does not mean that they do not apply to the fee schedule. Instead, these codes fall into the evaluation and management family of codes.

Healthcare professionals will often provide their contact numbers to patients. This allows the patients to reach out to the doctor for general queries. However, if there needs to be a true consultation over the phone, the healthcare provider can charge the patient for the remote interaction.

This is where CPT codes come in, and they dictate a system of charging the patients for telemedicine practice according to different factors. The telephonic codes are divided by the duration. Healthcare professionals must document the telephonic conversation and its medical necessity in this instance.

Online Digital Health Codes

The second set of codes is for the online digital telemedicine services. This is what took over the healthcare industry during the coronavirus pandemic. It involves the online platforms that enable physicians and patients to video conference and monitor vitals. These codes are also divided by timeframes, and they require an online, two-way visual conversation.

Related: How to develop a telemedicine application

Rules on Billing and Telemedicine Codes

With the onset of digital healthcare and its incredible prospect for the future, patients and physicians need to be aware of them. It would help if you remembered that while some of these rules may be covered while others may not be. Healthcare practices need to find out about this from the payers individually.

Some payers clarified what you can and cannot do. Billing codes is a subject that can be confusing for practitioners. It is very important to understand what your allowances are from your board, along with your coverage.

You should also be considerate of the HIPAA requirements . They relaxed the rules on the security of information during crises. This is because people often have to reach doctors in the state of an emergency. You cannot tell whether the board decision-makers at HIPAA will intervene in the future.

This is why healthcare workers need to stay on top of the legislation. You may have to store and record patient data if you have coverage. But, make sure that you are not violating any rights to the privacy rule. To ensure that you are complying, you have to keep your HIPAA updated.

A breach could be devastating for a healthcare professional’s practice. It can lead to you losing your license. This is also a reason to ensure you always check Medical Review Policy.

Every payer has put out a medical review policy for telehealth and telemedicine. Overall, the steps to keep your telemedicine practice safe will involve checking with your payer and making sure that your HIPAA is updated.

Coding And Modifiers For Telehealth Services

• 95 – If you are going to bill for telehealth more often, you have to get used to the 95 modifiers. This modifier refers to asynchronous telemedicine service rendered by an interactive video or audio communication system in real-time.
• CR – This modifier pertains to the service you have rendered related to a catastrophe or disaster. You can apply this modifier for emergencies.
• GQ – You can apply this modifier via asynchronous communication. Some plans want you to build this while others do not require it. This modifier was around even before the coronavirus outbreak. This is part of a federal telemedicine project.
• GT – This modifier applies to an interactive video and audio telecommunication system. You have to bill this code under the CAH Method 2. The CAH method  is short for critical access hospitals. Some payers will reimburse based on appendix-P. However, appendix P is very rare.  

Box 24B: Place of Service Codes

There are about 70 different places of service codes. Most healthcare providers are used to one of them, which is the number 11. This number refers to the office, while the number 2 means telehealth, and the number 12 means home.

For clients that go to the patient’s place of employment, the number is 18. There are also place-of-service codes for hospitals, nursing homes, and assisted living facilities. Similarly, you also have the telehealth site locations.

If you are going to provide telehealth, you will have to document the site locations so you do not forget about them. The site location includes the “originating site” and the “distant”. The originating site declares the patient’s location, and the “distant” code refers to where the healthcare provider is present at the time.

Billing managers should be aware that the originating site location will not include the home. The home is not normally considered an original location, but it is now included in the originating location due to the coronavirus pandemic. The 1135 waiver covers this part of the change.

New Diagnosis Codes

For nurse practitioners offering telemedicine services, it is important to note that there are new diagnosis codes. These codes are related to the covid-19 virus, and they represent respiratory infections, upper respiratory infections, pneumonia, coughs (r05), and shortness of breath (r0602) , unspecified fever (r50.9).

As a nurse practitioner, you will have to update your diagnosis codes since you will most likely deal with this. These codes can also be subject to further updates and replacement. This is why you have to stay on top of all the regulatory changes.

How to Bill for Telemedicine Visit?

Understanding the nuances of billing and coding for telemedicine can be difficult, especially considering their changes. These changes were a response to the public health emergency. Payers, including CMS and private payers, have significantly expanded their telehealth availability regarding coverage and payment.

This helps increase patients’ access to healthcare providers in times of uncertainty. The telemedicine codes allow patients to receive care remotely and get reimbursed appropriately. For some practitioners, billing a code can be very confusing. Understanding the best ways to bill for the services they provide will optimize reimbursement and allow them to continue practice operations.

Mentioned below, is a list of codes that can allow you to bill for some of the common telehealth services during the covid19 pandemic.

CPT: G2012 (5 – 10 mins)

This is a virtual check-in code. A virtual check-in code is designed to be a 5 to 10-minute phone call or video chat. This phone call or video interaction helps a patient determine the issue they are currently experiencing and whether it warrants a more extensive visit via in-person or telemedicine.

This is not meant to be an extensive evaluation, and you can also perform it with the help of a staff member and not necessarily with a provider.  When using this code in the billing process, you can use your usual place of service. For a regular clinic, the place of service would be 11, and you would not need to apply any modifiers.

CPT Code: G2010

This next new code that has become available to allergists during the coronavirus pandemic involves remote review of images and video. An example of this is  a patient sending an image through the patient portal to review and give opinions. For outpatient clinics, the place of service will be 11, and you will not have to use any modifier.

Telephone care is a service that most often goes uncompensated. Many doctors have previously provided free over-the-phone care to their patients. Nonetheless, during public health emergencies, payers have recognized that telephone care is much significant for some patients. These patients do not have video conference availability.

Therefore, the codes already established for telephone care are being reimbursed. Below is a list of codes that healthcare professionals can use for billing telephone visits.

• 99441 (5-10 minutes)
• 99442 (11-20 minutes)
• 99443 (21-20 minutes)

The place of service will depend on where you are practicing from, and the modifiers are typically not necessary. Next, you have synchronous face-to-face video visits. In other words, the telemedicine visits. These codes are billed using the standard codes that a healthcare provider normally uses for patient care.

Previously, it has been very difficult to get telemedicine coverage delivered to new patients. This is because many states and payers have requirements. These requirements need individuals to establish patients of the specific practice. Moreover, states require a physical exam on file before a healthcare professional or billing manager could bill for telemedicine services.

During the public health emergency, this has been waived, and you now have the opportunity to provide your new patient’s telemedicine care easily. You can do this by using your standard codes, which are 99201, 99202, 99203, 99204, and 99205 . You can bill them using a time-based approach or medical-decision billing approach.

For established patients, the rules will apply the same way. The codes are 99211, 99212, 99213, 99214, and 99215 . This applies to either time-based billing or medical decision-making.

Historically, the place of service designated for telemedicine is 02 , which designates telemedicine visits. However, many payers have reimbursed telemedicine care at a lower rate than live visits.

To simplify coding and billing processes, the guidance for most pairs has been to use the usual place of service to guarantee payment parity and optimize your reimbursement. Therefore, while using a place of service 11, you would then use a modifier 95 or GT to designate the telehealth services.

This is not a uniform recommendation amongst all payers. TRICARE and Aetna, along with a number of state medicare plans still give the guidance to use 02 as the place of service. The best way to find out how to bill would be to reach out to your payer for advice.

A new code that people can use during the public health evaluation for most payers includes the digital health evaluation code. You can also refer to this code as the E-visit code.

You would use this code when a patient reaches out to you for medical guidance via a secure electronic guidance portal such as the HIPAA compliance portal. Generally, this code would only apply if the patient initiates the visit.

An interesting thing about billing for digital health evaluation or E-visit codes is that they are accumulative time-based systems that run over seven days.

Healthcare professionals have to add up the time they spent reviewing, responding, and researching for a single patient for seven days. Once they review the time, they can add it all up and bill for the accumulative amount of time.

The codes for digital evaluation are:

• 99421 ( 5-10 minutes)
• 99422 (11-20 minutes)
• 99423 ( greater than or equal to 20 minutes)

COVID-19 Regulatory Changes and Updates

Several changes took place regarding telehealth services. On March 17 th CMS issued guidance towards the Secretary Azar’s Waiver Authority. This broadens the access to Medicare services for telehealth. Although telemedicine services are not new, CMS announced waivers for them because more and more people are now using them.

Typically, when you bill telemedicine services to medicare, they only pay for certain services. It’s also worth keeping in mind that there are about 101 CPT codes that qualify for telemedicine, according to medicare.

This has broadened immensely during the public health emergency. You can now find several different codes that are eligible. You also no longer have to use the modifier GT and as you can use the modifier 95 instead. This is the modifier that most commercial insurance use to indicate when billing for a telemedicine service and not a physical practice.

Medicare Requirements

When you bill these services to medicare, they only pay for certain specific ones. You will have to bill with the modifier GT, indicating that the service was telemedicine. There are about 101 CPT codes that qualify for telemedicine practices. These services must be patient-initiated, which means that physicians will only apply them if a patient reaches out to the doctor and not the other way around.

Geographical Restrictions waived

There are many restrictions that the federal authorities have waived to make telemedicine health services more widely available. Telehealth services were not popular before the pandemic because you could not perform the service for any patient in any area of the country. Instead, there were particular locations.

To bill for telemedicine services, patients had to be in a rural area where they did not have easy access to medical facilities or a healthcare provider. Therefore, Medicare would cover them for their digital checkups and monitoring.

As the public health emergency came about and authorities started mandating social distancing policies to reduce exposure and spread of the virus, the decision-makers lifted this waiver. This allows any physician to perform and bill for digital healthcare service regardless of the patient’s location.

Originating Location Requirement Waived

Another element of the billing restrictions was that the patient could not be in the comfort of their home. They instead had to travel to a nearby hospital or clinic that had types of equipment set up for them to perform audio and visual interactions. This qualified as an originating site in the modifiers.

However, since the covid19 pandemic encouraged every patient to stay within their premises, this restriction has also been waived. A patient’s home now qualifies as an originating site as well.

Final Words

It is important to realize that much of the telehealth expansion is temporary. This is not to say that telehealth expansion and payers are not currently in place. These expansions and new billing updates are likely to extend and change in response to the CMS recommendations.

• CCM (Chronic Care Managmenet)
• Care Coordination
• Preventitive and Wellness Programs
• Product Updates
• RHCs / FQHCs

«  View All Posts

Annual Wellness Visit

Annual Wellness Visits (AWV): CPT Codes, Billing, and Reimbursements

• Share This Article

April 6th, 2022 | 2 min. read

Loran Sekely

Account Manager

Print/Save as PDF

In this video, we explain the 2022 CPT codes, billing requirements, and reimbursements for Annual Wellness Visits (AWV), so you can properly bill for this program and maximize your revenue.

Annual Wellness Visits are an effective way to embrace value-based care, so it’s important to understand the program's rules and regulations, as well as the different types of AWV your practice can offer. We’ll cover the differences between Initial Preventive Physical Examinations (IPPE), Initial Annual Wellness Visits (IAWV), Subsequent Annual Wellness Visits (SAWV), and Advanced Care Planning (ACP).

After watching, you’ll have a better understanding of the elements of an AWV including health risk assessments (HRA). You'll also know how to bill for each type of visit if you’re a physician practice, rural health clinic (RHC), or federally qualified health center (FQHC).

We’ll cover the CPT codes for physician practices and RHCs with codes G0402, G0438, and G0439 and the CPT code G0468 for FQHCs. We’ll also discuss CPT code 99497 for Advanced Care Planning and when this can be added to a wellness visit.

Finally, you’ll learn how an AWV can identify preventive health services for patients and promote enrollment in additional care management programs, such as Chronic Care Management (CCM), Behavioral Health Integration (BHI), and Remote Patient Monitoring (RPM).

Want more information on AWV programs? 

Read about the   2022 CPT codes for AWV , learn more about the  3 types of Annual Wellness Visits , or dive deeper into health risk assessments.

DATELINE FRIDAY SNEAK PEEK: Chameleon

DATELINE FRIDAY PREVIEW: Chameleon

DATELINE SUNDAY SNEAK PEEK: At the Edge of Town

DATELINE SUNDAY PREVIEW: At the Edge of Town

A Postcard from the Field: The Grackles of Austin, Texas

A Postcard From the Field: Versailles Restaurant

A Postcard from the Field: The Lincoln-Douglas Debate Interpretive Center

A Postcard from the Field: The Edmonton Oilers

A Postcard from the Field: Maricopa County Sheriff's Office Animal Safe Haven

A Postcard from the Field: The Victorian on Main

A Postcard from the Field: Dick’s Den in Columbus, Ohio

A Postcard from the Field: Bull Shooters

A Postcard from the Field: The Mirror Lake Diner

A Postcard from the Field: The Ozark Folk Center State Park

A Postcard from the Field: Edwards Air Force Base

A Postcard from the Field: Frocked Up in Lake Havasu, Arizona

A Postcard from the Field: The Glenturret Distillery

A Postcard from the Field: Europe’s Largest Boat Lift

In the Field: Filming in a deep freeze

A Postcard from the Field: Salem Sue

Andrea Canning reports Friday, April 26 at 9/8c on NBC. April 24, 2024

Best of NBC News

NBC News NOW

Israeli airstrikes hitting areas in gaza that idf designated as 'safe zones'.

Man on deathbed confesses to murder of mother and daughter after 24 years

Third American arrested in Turks and Caicos for allegedly having ammunition

South Carolina residents calling police over noisy cicadas

9-year-old boy wins seagull screeching competition

Nightly News Netcast

Nightly news full broadcast (april 26th).