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Wiki Telehealth 2025 Final Rule

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gcmc11528

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My understanding is the Telehealth Final Rule 2025 as of now will return to pre-pandemic rules and the patient would need to be in a rural area in order to use telehealth services starting on 1/1/25 for a normal e/m visit.
There are a few articles online that said congress passed an extension until March 2025 however I can't find anything stating this on CMS or AAPC.
Does anyone know if the extension is true?
 
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Is the below statement accurate? I understand the deletion of the codes 99441-99443 and that CMS will not accept the new AMA codes for telehealth. I work in Palliative Care home visit realm. Does this mean that we can continue to bill the the appropriate E&M visit with specific modifier even if this is in the patient's home through March 31st now. I've watched a AAPC webinar where the home is no longer an allowable originating site. I believe with the expansion of the telehealth to March 31, 2025 we can still code these in the home.
  • CMS Telehealth Rules: CMS will not adopt the new AMA codes and will continue using existing in-person E&M codes with modifiers:
    • Use the appropriate E&M code with a 95 modifier for audio/video visits.
    • Use the appropriate E&M code with a 93 modifier for audio-only visits if the provider has video capability but the patient cannot or refuses to use it.
 
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When trying to look up new fee schedules for 2025, 98000-98016 aren't in any fee schedules. Is this because these codes don't go into effect until after 3/31/2025 and we continue to use E/M codes until then?
 
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leastratton1001 said:
Is the below statement accurate? I understand the deletion of the codes 99441-99443 and that CMS will not accept the new AMA codes for telehealth. I work in Palliative Care home visit realm. Does this mean that we can continue to bill the the appropriate E&M visit with specific modifier even if this is in the patient's home through March 31st now. I've watched a AAPC webinar where the home is no longer an allowable originating site. I believe with the expansion of the telehealth to March 31, 2025 we can still code these in the home.
  • CMS Telehealth Rules: CMS will not adopt the new AMA codes and will continue using existing in-person E&M codes with modifiers:
    • Use the appropriate E&M code with a 95 modifier for audio/video visits.
    • Use the appropriate E&M code with a 93 modifier for audio-only visits if the provider has video capability but the patient cannot or refuses to use it.
Click to expand...
You are correct, E&M office visit + modifier, through March 31st, or longer if Congress agrees to extend it again - the first bill was for 2 years, so maybe we'll get lucky again.

The telephone-only codes have been deleted (99441-99443), telephone-only "visits" are no longer permitted. (There are many services where telephone contact is still permitted, such as Transitional Care Management, etc. but not for the "usual" E&M visit.)
Audio-only visits are still permitted for telehealth services as long as the physician/APP/service provider has capabilities for approved audio-visual telecommunications technology. The patient may not have technology or may not want to use video, which is fine, then the visit is conducted audio-only. We do not call it a telephone visit because the provider is supposed to have appropriate technology (which a telephone is no longer appropriate technology by itself for the provider). If your visit results in audio-only, that is permissible.
 
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eharloff said:
When trying to look up new fee schedules for 2025, 98000-98016 aren't in any fee schedules. Is this because these codes don't go into effect until after 3/31/2025 and we continue to use E/M codes until then?
Click to expand...
Those codes will not be on Medicare fee schedule. They have stated in the final rule there are already other codes to use - the E&M visit codes. We are following billing rules for MC and for those we know follow MC rules. All others will be billed with the new tele codes until we get denials telling us otherwise. Some carriers may not have 2025 fee schedule published yet but if they do and those codes are not on it, it would seem they want the usual E&M codes.
 
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jtimothy said:
Add on question to this thread---does this apply only to Medicare? Are commercial insurances accepting the new telehealth codes starting 1-1-25?
Click to expand...
We have set up our system to bill the usual E&M codes for MC and those carriers we know follow MC. All other commercial payors will be billed with the new tele codes (until we get denials).
 
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clbcarey@comcast.net said:
Am also looking for clarification after reading the extension till 3/31/25. What Cpt codes are we to use as of Jan 2025 due to the extension for Medicare and comm payors?
This is not clear to me at all.
Thank you!
Click to expand...
CMS stated in the final rule there are already other codes to use - the E&M visit codes - so they will not recognize the new tele codes. We are billing the usual E&M+93/95 modifier for MC and for those we know follow MC rules. All others will be billed with the new tele codes until we get denials telling us otherwise.
 
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Are we still allowed to use the 93/95 modifier for E&M 99202-99205 or 99212-99215 even though those codes are not listed in the allowed CPT codes for these modifiers in Appendix T and P of the CPT book? 99211 is listed as being allowed to be billed with the 95 modifier, not 93. I'm not sure if the payers have to abide by those rules or if they can still choose to use them.
 
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jtimothy said:
Add on question to this thread---does this apply only to Medicare? Are commercial insurances accepting the new telehealth codes starting 1-1-25?
Click to expand...
I have the exact same question. We are commercial only and BCBSIL does show the new Telemedicine E/M codes in their fee schedule in Availity but I only just submitted a few claims so far and haven't received any feedback yet. So i am also wondering if the telemedicine E/M codes wont technically be active until 4/1/25?
 
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eharloff said:
When trying to look up new fee schedules for 2025, 98000-98016 aren't in any fee schedules. Is this because these codes don't go into effect until after 3/31/2025 and we continue to use E/M codes until then?
Click to expand...
I was only able to see new telemedicine codes 98000-98016 starting on 1/1/25 using availity for our commercial payer BCBIL. However i have not had any of our claims with this new codes processed yet so I'm not sure if they are ACTUALLY active yet or wont start being accepted until 4/1/25?
 
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