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Internal Medicine Coding Alert

Reader Question:

Get Paid for Telehealth Consultations

Published on Tue Feb 10, 2004

Questions: We heard that CMS introduced a new code for physician-to-patient Internet consultations. Is this true? Also, what are the requirements for reporting the code?

North Carolina Subscriber

Answer: Although Medicare has not introduced a code for Internet consultations, the government does offer payment guidelines for telehealth or telemedicine services. Generally, telehealth involves a physician consulting with a patient in another location via interactive video or television.

You may report telecommunications consultations, office visits, individual psychotherapy and pharmacologic management as a substitute for a face-to-face or "hands- on" encounter, according to the Medicare Carriers Manual (MCM), section 15516.

Medicare accepts the following codes when reporting telehealth services:

  •  consultations (CPT codes 99241-99275)
  •  office or other outpatient visits (CPT codes 99201-99215)
  •  individual psychotherapy (CPT codes 90804- 90809)
  •  pharmacologic management (CPT code 90862).

    But before you submit these codes to Medicare, make sure the patient is treated in a hospital, critical-access hospital, rural health clinic or federally qualified health center that Medicare has defined as a rural health professional shortage area (HPSA), or has received an exception to rural HPSA requirements.

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