# Telemedicine visit



## nataberr@gmail.com (Jan 21, 2019)

Hello,

I am getting differing answers so thought I would see if anyone had any insight.

How would you code for a 30 minute telemed appt, with Premera as the payor? 
If it was a face to face visit, it would be 99214. 

Thanks in advance!


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## mitchellde (Jan 21, 2019)

Assuming you have met all the criteria for telemedicine, as in the patient is not in their home and they are located at a qualified originating site and your provider is a qualified distant site provider then you just bill the same as you would for a face to face service however instead of the POS  being 11 you use 02 and for commercial payers you use modifier 95.


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## nataberr@gmail.com (Jan 22, 2019)

mitchellde said:


> Assuming you have met all the criteria for telemedicine, as in the patient is not in their home and they are located at a qualified originating site and your provider is a qualified distant site provider then you just bill the same as you would for a face to face service however instead of the POS  being 11 you use 02 and for commercial payers you use modifier 95.



Thanks Debra! Very helpful.


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## Provider492 (Jan 23, 2019)

*telemed*

Where are you getting your criteria for Telemed services?  Also would you bill an E/M code with the new CMS codes g2010 and g2012?

Julie T


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## mitchellde (Jan 23, 2019)

The criteria for telemedicine is listed on the Medicare website.  Since most carriers follow Medicare you can assume the same criteria applies to all carriers unless you have something different in writing from a specific carrier.  You would not use the G2010 or G2012 codes in addition as that is for a different type of telemedicine.  
G2010 is when the patient sends an image or video to the provider to review and the provider has a 5-10 minute discussion with the patient regarding the image or video, meeting again the requirements for telehealth and the patient cannot be in their home of office.
G2012 is for a check in with between the patient and the provider regarding an issue that is currently under care to see if a face to face is needed.  Again meeting all the other requirements for telemedicine.
If you are wanting to provide telemedicine services you should really look up the requirements for this.  The first audit conducted last year by Medicare showed that most were not following the requirements and more than 60% of all payments were recouped.
I have done a lot of research into this for my classes.. here is a place to start your search put this in your search bar:
42 CFR § 410.78(b)


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## Provider492 (Jan 24, 2019)

Thank you for the information.  I will start looking into the different services.


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## Provider492 (Jan 24, 2019)

Here is another good link with information
https://www.cms.gov/Outreach-and-Ed...NProducts/downloads/TelehealthSrvcsfctsht.pdf


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## SDodd (Feb 26, 2019)

*Additional Telemedicine Information Request*



mitchellde said:


> Assuming you have met all the criteria for telemedicine, as in the patient is not in their home and they are located at a qualified originating site and your provider is a qualified distant site provider then you just bill the same as you would for a face to face service however instead of the POS  being 11 you use 02 and for commercial payers you use modifier 95.



Do you have any resources that explain how a new/initial patient telemedicine visit 99201-99205 is billable when the physical exam cannot be performed?  There seems to be extremely limited explanation about time based billing when all three key components of an initial visit can't be met.  It seems that billing the E/M based on HPI, an extremely limited visual exam of the patient online, and MDM is going to require the additional documentation of time and possibly even counseling and coordination of care with the patient's other providers in order to properly bill for the service rendered.  Any additional resources you could recommend for review?   We are not asking about Medicare in any way, no originating or distant site billing either.  We are considering offering telemedicine visits to commercial and Medicaid patients in states that allow telemedicine with the patient in their home.   The program is trying to reach out to patients that do not have consistent follow up with their regular providers and will not agree to an in home assessment with a provider.  We are hoping that telemedicine may help convince patients to accept a provider visit to help assess patients chronic conditions that may not be getting appropriate care.  Thank you in advance for any information you can provide


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## mitchellde (Feb 26, 2019)

I am not sure a new patient encounter would qualify I am under the understanding that these must be established patients.  if you did have a new patient present the only way you could as telemedicine would be where the distant site provider would do the minimal constitutional and vital signs and communicate this to the provider.  But if you are able to find a payer or state that allows the patient to be at home I don't see how a new patient visit could be jusitifed.


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## SDodd (Feb 27, 2019)

*please confirm my reply to coworkers*

Thank you for your feedback Debra!  Please review the following statement to see if I would be explaining properly to team members I am working with on this project.

"CPT 99201-99205 are allowed for Telemedicine (and use approximate time based examples in the code descriptions), however, there must be a History, Exam, AND Medical Decision Making for a New Patient.  Time should not be used in lieu of meeting those 3 key components for a new patient to the provider rendering the service.    Even if a commercial health plan or state's Medicaid plan tells us they allow a patient to be located in their home, and the plan allows Telemedicine, it will not be appropriate to bill for a new patient visit.  The new patient CPT codes 99201-99205 will require an examination in order to be reported and billed correctly."

Please advise if you would add or change anything.  Thank you again!


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