CPT Codes for Telehealth
Telehealth has revolutionized the way healthcare is delivered, prompting Centers for Medicare and Medicaid Services (CMS) to activate new Current Procedural Technology (CPT) codes for telehealth and remote patient monitoring (RPM). There is a level of complexity around telehealth reimbursement, but the new CPT coding standards are very similar to those used for an in-office exam. In addition to expanding CMS reimbursement to include telehealth visits, these new provisions will make it easier for telehealth providers to bill for services, especially for those living in rural areas. Laws vary state to state, so please refer to local resources on CMS.gov.
Telehealth services that are similar to existing services, such as professional consultations, office visits, and office psychiatry services are already approved for telehealth delivery. In deciding whether to approve the new codes, similarities between the requested and existing telehealth services are examined, including interactions among the patient and the practitioner at the distant site and, if necessary, the telehealth clinician, and similarities in the technologies used to deliver the proposed service.
To receive reimbursement, patients must be at an approved medical site (list below) which may or may not include a home originating site as local laws vary, and it must meet geographic requirements. Determine eligibility here.
As of 1/1/18, providers must use the POS (Place of Service) 02 code to bill for telehealth services. This eliminates the need to use the GT modifier to designate interactive audio/video. It cuts down on the billing administrative burden and makes it unnecessary for the distant-site practitioner to report the GT modifier on the claim. Find your relevant CPT codes here.
Originating facilities currently eligible for Medicare telehealth-delivered services:
Critical access hospitals (CAH)
Rural health clinics
Federally qualified health centers
Skilled nursing facilities
Community mental health centers
Hospital-based or critical access hospital-based renal dialysis centers
The originating site must be in a Health Professional Shortage Area (HPSA) as defined by Health Resources and Services Administration (HRSA), or in a county that is outside of any Metropolitan Statistical Area (MSA) as defined by the US Census Bureau. HRSA also maintains a Medicare telehealth payment eligibility search tool, where eligibility of an originating site may be checked.