Wiki Telemed codes 99421-99423, Do they have to be Video or is a phone call OK?

[mperez1212]

With the Covid-19 in our area our providers are interested in beginning Telemed visits. I see that CPT in 2020 has added new codes for this. The code says Online E/M services via a secure platform
just checking to see thoughts or if someone has some experience with these new codes yet?

 

[csperoni]

If you are referring to 99421-99423, those are for ONLINE services only. If you are performing telephone encounters, 99441-99443 are the codes you are looking for. Please note these are for established patients only.
I can't speak to the coverage of these codes by insurance as we do not use them in our practice.

 

[mitchellde]

The differences between the 99441-99443 codes and telemedicine are for the 99441-99443 codes the patient must initiate the service, not the provider, also for telemedicine the patient cannot be located in the home or workplace at the time of the service, they must be in a approved originating site.
if you look in the code book you will find the rules for the use of the 99441-99443 codes.

 

[Yarbs]

These codes are not considered "Telehealth" by CMS but as "virtual care." If the patient is in the home - much like using G2012 or G2010 - it doesn't matter where the patient is located.
Be sure to check the CMS site for the PFS 2020 downloads for Telehealth Codes. These codes are not on there.

 

[GHSimson]

The differences between the 99441-99443 codes and telemedicine are for the 99441-99443 codes the patient must initiate the service, not the provider, also for telemedicine the patient cannot be located in the home or workplace at the time of the service, they must be in a approved originating site.
if you look in the code book you will find the rules for the use of the 99441-99443 codes.

I am getting inundated with questions regarding telemedicine coverage. The problem with telemedicine and Covid-19 is that the patient must come to the office for services due to the originating site requirement. This completely defeats the purpose. Has anyone heard anything about this rule being lifted? BCBS of Michigan states that there is "no originating site requirement", it seems like this would mean that the originating site could be the patient home, but I am not confident.

 

[Sandrath]

NC Medicaid just released a new bulletin today on their website explaining General guidance and Policy Modifications for the CPT codes G2012 and CPT codes 99441-99443. The site is https://medicaid.ncdhhs.gov/providers/medicaid-bulletin. By using a modifier CR on any of those CPT codes that will bypass time limitations(7day or 24 hour).

 

[SharonCollachi]

The simpler way of saying what the Telephone Services codes (99441-99443) are for, is that the patient calls in with a problem and the licensed provider gets on the phone and talks to them. It is not for a scheduled appointment. If the provider decides to see the patient within 24 hours OR at the next available urgent appointment slot, then you do NOT bill for the phone call, it is included in the E&M service.

If the patient calls within seven days of an office visit they've already had, or it is within the postop period of a procedure, it is also NOT billed (whether you told the patient to call and check in or not).

Unless an insurance company sends out a notice stating that patients can be treated via phone call, and how to bill that, then I wouldn't try to bill it. If the patient wants a phone visit, and the provider agrees to a phone visit, then it's cash pay.