• Piyush Kedia

Billing for Telephone Only (Telemedicine) Visits

Our patients dont have a video capable device, can we bill for telephone only visits

This is the most common question we have received from physicians over the past week

With Waiver 1135 Most payers are covering regular office visits (99201- 99215) using telemedicine. This code requires the visit to be performed using Audio and Video communication and cannot be used when the patient does not have video.

A lot of patients on Medicare do not have access to video enabled devices but still need remote care. Providers can use the following CPT Codes for providing Virtual Check In's using a telephone call (No Video)

Below is coverage by payer for telephone only Virtual Checkin visits


CPT G2012:

Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

Commercial, Medicare Advantage and Medicaid carriers

The following CPT Codes are eligible for for telephone only visit:

(I would still recommend checking your specific carrier websites)

99441- Physician /Qualified Health Professional telephone evaluation 5-10 min

99442 - Physician /Qualified Health Professional telephone evaluation 11-20 min

99443 - Physician/Qualified Health Professional telephone evaluation 21-30 min

The Reimbursement ranges from $15 to $50

Documentation Guidelines

- Verbal consent acceptable but needs to be documented

- Document that the service was provided by telephone 

- Time in and Time Out

- Reason for the visit

- Summary of the conversation/ visit

- Outcome of the conversation/ visit

Important to note - The visit can't be related to an E&M Service provided over the last 7 days

- The visit can't trigger a face to face visit within the next 24 hours

- Only established patients are eligible for a virtual visit, new patients are not eligible

CMS has also authorized which practitioners may be reimbursed for Telehealth services. In accordance with CMS these practitioners are listed below:

* Physician

* Nurse practitioner

* Physician assistant

* Nurse-midwife

* Clinical nurse specialist

* Clinical psychologist

* Clinical social worker

* Certified Registered Nurse Anesthetists

* Registered dietitian or nutrition professional

Please email pk@empclaims.com if you would like specific clarification.


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