Telemedicine Codes

Telemedicine Codes

Modifier 95

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

CPT Codes

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.

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).

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