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 SleepTM, a state-of-the-art telemedicine system for sleep medicine professionals, accredited sleep centers and durable medical equipment providers.
- AASM Coding FAQs
- Introducing Telemedicine Into Your Sleep Practice webinar, which discusses the implementation of telemedicine in the practice of sleep medicine, resources for setting up a telemedicine service, and legal and regulatory issues.
CMS Telemedicine/Telehealth Codes
The codes below are commonly reported for Medicare patients:
|Telehealth Visits||Description of Service||New Patient||Established Patient|
|99201 – 99215||Office or other outpatient visits||X||X|
|G0425 – G0427||Telehealth consultations, emergency department or initial inpatient||X||X|
|Virtual Check-ins||Description of Service||New Patient||Established Patient|
|G2010||Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, 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||X|
|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||X|
|E-Visits||Description of Service||New Patient||Established Patient|
|99421 –99423||Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes||X|
|G2061 – G2063||Online assessment by qualified non-physician healthcare professional||X|
|Telephone Services||Description of Service||New Patient||Established Patient|
|99441 –99443||Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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||X|
|Interprofessional Telephone/Internet/EHR Consultations||Description of Service|
|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
*Each code includes time for medical consultative discussion and review
|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|
|99452||Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/ requesting physician or other qualified health care professional, 30 minutes|
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.
|HCPCS Level II Telehealth Codes||Type of Service||New Patient||Established Patient|
|G0406-G0408||Follow-up Inpatient Consultation via Telehealth||X|
|G0425-G0427||Telehealth Consultation, Emergency Department||X|
|G0508, G0509||Telehealth Consultation, Critical Care||X||X|
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.
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
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