The 2017 CPT® manual features a new Appendix P, which lists 79 CPT codes that may be appended with the 95 modifier to report synchronous (real-time) telemedicine services. Some of the code families included in the list are: video-conferenced critical care services codes (0188T and 0189T), health and behavior assessment codes (96150-96154), and education and training for patient self-management codes (98960-98962).
|Appendix P Codes||Description|
|0188T, 0189T||Video-conferenced Critical Care Services|
|90791, 90792||Psychiatric Diagnostic Evaluation|
|90832-90838, 90845-90847, 90863||Psychotherapy Services|
|90951-90955; 90957, 90958; 90960, 90961||End-Stage Renal Disease Services|
|92227, 92228||Ophthalmoscopy Procedures|
|93228, 93229, 93268, 93270-93272||Cardiovascular Monitoring Services|
|93298, 93299||Implantable and Wearable Cardiac Device Evaluations|
|96040||Genetic Counseling Services|
|96116||Central Nervous System Assessments/Tests|
|96150-96154||Health and Behavior Assessment/Intervention Procedures|
|97802-97804||Medical Nutrition Therapy Procedures|
|98960-98962||Education and Training for Patient Self-Management|
|99201-99205, 99212-99215; 99241-99245||New or Established Patient Office or Outpatient Services|
|99231-99233||Subsequent Hospital Care|
|99251-99255||New or Established Patient Inpatient Services|
|99307-99310||Subsequent Nursing Facility Care|
|99354, 99355||Prolonged Service With Direct Patient Contact|
|99406-99409||Behavior Change Interventions, Individual Services|
|99495, 99496||Transitional Care Evaluation and Management Services|
In addition to Appendix P codes, the 2017 CPT Manual includes several telemedicine codes that include services in the code descriptions.
|CPT Telemedicine Codes||Type of Service|
|99444||Online Evaluation and Management Service|
|99946-99448||Interprofessional Telephone/Internet Consultation|
HCPCS Level II Codes
There are also HCPCS Level II codes that describe telemedicine services in the code descriptions.
|HCPCS Level II Telehealth Codes||Type of Service|
|G0406-G0408||Follow-up Inpatient Consultation via Telehealth|
|G0425-G0427||Telehealth Consultation, Emergency Department|
|G0508, G0509||Telehealth Consultation, Critical Care|
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).
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