Wiki Preventive via Telehealth

[osanders]

Are comprehensive CPT codes 99381-99397 appropriate for preventive visits performed via telehealth? We have been asked about billing 99381 - 99397 for comprehensive Preventive visits performed via telehealth. I had thought these codes inappropriate due to typically including things like pelvic exam, scoliosis exam, testicular exam which cannot be performed via telehealth. These codes are not listed in AMA's appendix P as allowed with modifier 95 or on CMS's telehealth list. I was thinking G0438 or G0439 annual wellness or office codes already accepted for telehealth 99202-99215 that would meet the exams that could be performed via telehealth.

 

[thomas7331]

99381-99397 are not covered by Medicare in any case, so you'd need to check the policies of your commercial payers to see whether or not they would allow this as a telehealth service. However, I don't see how a provider could complete a comprehensive preventive service via telehealth without performing a hands-on exam, so I wouldn't recommend this.

CPT code 99202-99215 are not preventive services, they are problem-oriented services that require a chief complaint, so you can't substitute those codes for preventive exams. Most of the components of the AWV, G0438/G0438, can probably be done via telehealth (I'm not sure if Medicare allows this or not), but these do not include a routine preventive examination, which is a service that Medicare excludes from coverage.