Wiki Telehealth Coding Changes PCP 2025

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I made a summary of the issues as far as I could determine. Please check my work and add other relevant info:

The authorization for Medicare to pay for telehealth and audio-only telehealth has been extended through 3/31/2025 (see page 102-4).

As of 1/1/2025 99441-3 (telephone visits by a physician) have been deleted. 98966-8 (telephone visit by APP) remain, but I think will not be used. The link is Medicare's publication of codes for telemedicine.

Excerpt:
21299441Phone e/m phys/qhp 5-10 minDeleteprovisional
21399442Phone e/m phys/qhp 11-20 minDeleteprovisional
21499443Phone e/m phys/qhp 21-30 minDeleteprovisional

As of 1/1/2025, CPT is using 98000-98016 for telehealth and audio-only telehealth. Medicare is not using these codes as of now. But some private payers may.

The Medicare publication cited below confirms that as of 7/8/2024 we should code all telehealth E/M with codes 99212-5. For audio-video telehealth, add modifier -95; for audio-only telehealth, add modifier -93. We can use either of two POS codes, 02 (Pt receiving telehealth, not at home) or 10 (pt receiving telehealth at home). POS 12 (Home services) will not be covered. Presumably this is still the intended way to bill in 2025. The old telephone codes (99441-3) required initiation by the patient and could not deal with issues that had been addressed in the last 7 days or were to be addressed at the next available appointment. These restrictions do not appear in the descriptions of 99212-5, and I suspect do not apply. For 99441-3, only the time on the phone would count. For 99212-5, the entire work time on the day of the visit should count. Audio-only is now paid at the same rate as audio-video.

Beginning in CY 2024, practitioners may receive either the facility or the non-facility payment rate for an otherwise eligible Medicare telehealth service, depending on whether the billing practitioner selects POS code 02 or POS code 10. The only two valid POS codes for Medicare telehealth billing in CY 2024 are POS 02 and POS 10. As appropriate, POS 02 or POS 10 may be used and must be paired with the appropriate telehealth modifier (modifier 93 for audio-only and modifier 95 for audio/video). The payment rate for POS 02 is the facility payment rate (F); the payment rate for POS 10 is the non-facility rate (NF). Use of audio-only (93) or audio-video (95) does not change rate of payment, only the POS code determines the non-facility or facility payment rate.

I have seen references that for 2025, the Medicare definition of "telehealth" was proposed to include audio only (if the provider is capable of video but the patient is unable or unwilling). This might mean that some audio-only visits might be coded with modifier -95. I have not seen that this proposal was implemented.

CMS proposed that beginning January 1, 2025, an interactive telecommunications system may include two-way, real-time audio-only communication technology for any telehealth service furnished to a beneficiary in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system but the patient is not capable of, or does not consent to, the use of video technology.
 
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The Haugen Group put out an article explaining that Congress passed a bill " The American Relief Act of 2025" stating that for Medicare you can use the E/M codes 99202-99215. However, other payers have different guidelines so you would need to check with specific payer. I hope this helps some
 
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