By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    An Expert’s Guide To Building and Improving Endurance
    June 30, 2022
    medical assistants
    What Do Medical Assistants Do On a Day to Day Basis?
    April 5, 2022
    superfoods to help with prostate health
    10 Healthy Foods That Can Help Protect Your Prostate
    August 29, 2022
    Latest News
    Getting Back in the Game: Sports Injuries Rehabilitation Tips
    May 31, 2023
    4 Signs It’s Time to See a Therapist
    May 24, 2023
    11 Ways To Modernize Your Private Practice
    May 17, 2023
    How to Recognize the Signs of Hormonal Imbalance in Men
    May 29, 2023
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Breaking Through The Stigma Of Addiction: Why It’s Okay To Ask For Help
    September 30, 2018
    ONC Releases RFI on Catalyzing Interoperability of EHRs at HIMSS13
    March 7, 2013
    cannabis healthy
    7 Creative And Practical Ways To Use Cannabis
    February 5, 2020
    Latest News
    MRI Sedation Options: What You Should Know Before Screening
    May 17, 2023
    What is the Process of Creating Medicine from Nature?
    May 2, 2023
    Choosing the Right Treatment Option for Varicose Veins
    May 2, 2023
    What Are Wrong-Site Surgeries and How Do They Occur?
    April 27, 2023
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Tackle Telemedicine Coding With These CPT® and CMS Pointers
Share
Sign In
Notification Show More
Aa
Health Works CollectiveHealth Works Collective
Aa
Search
Have an existing account? Sign In
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > eHealth > Medical Records > Tackle Telemedicine Coding With These CPT® and CMS Pointers
eHealthMedical Records

Tackle Telemedicine Coding With These CPT® and CMS Pointers

Sudhir Singh
Last updated: 2018/07/23 at 7:56 PM
Sudhir Singh
Share
5 Min Read
SHARE

 

Contents
Telemedicine CPT® Codes: Start With the Official AMA ListTelemedicine Medicare Codes: Tune In to Payer RequirementsResources: Keep Telemedicine Codes Close at Hand

An April 2018 OIG report on telehealth claims revealed CMS has agreed to conduct periodic post payment reviews and implement claim edits directed at this emerging area. To help your medical coding skills keep pace, here are some pointers on CPT® and Medicare telemedicine coding.

Telemedicine CPT® Codes: Start With the Official AMA List

The AMA, which holds copyright in CPT®, designates CPT® codes that you may use to report synchronous (meaning real-time) telemedicine services. To indicate to a payer that the service was a telemedicine service, you append telemedicine modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system).

Note that the descriptor for the telemedicine modifier indicates the use of interactive audio AND video telecommunications, so you must use both.

More Read

A Guide to Medical Billing Services for Small Practices

How to Use E-Cigarettes to Stop Smoking
Healthcare Blogging: How to Become a Trusted Medical Source
What Has the Medical Industry Learned from COVID-19?
Ethics of Social Media Success and Instagram Influencers in Healthcare

You should make sure you have an updated list of telemedicine CPT® codes each year so you can identify the services you perform that are on the list. For instance, you may not be surprised to learn there are many E/M codes on the list. But 2018 CPT® telemedicine procedure codes also include codes like these:

  • 92227 (Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral)
  • 93272 (External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; review and interpretation by a physician or other qualified health care professional).

Telemedicine Medicare Codes: Tune In to Payer Requirements

If telemedicine reimbursement is your concern, you should be aware that a payer’s list of covered telemedicine billing codes may not line up with the AMA’s list. And beyond that, the service is likely to have to meet a long list of requirements before it’s eligible for payment.

Medicare provides a good example. For instance, the 2018 list of Medicare Telehealth Services differs significantly from the AMA list. One major reason is that Medicare adds HCPCS G codes to the list of telemedicine/telehealth codes.

Medicare’s telemedicine/telehealth reimbursement policies also specify that the originating site must be in one of these locations:

  • A county outside a Metropolitan Statistical Area
  • A rural Health Professional Shortage Area in a rural census tract.

Don’t miss: An entity participating in a federal telemedicine demonstration project approved or funded by HHS also qualifies as an originating site. Those entities should be sure to review and follow the additional requirements and rules that apply to them.

Caution: The actual originating site needs to be one authorized by law, specifically one of these:

  • Community Mental Health Center
  • Critical Access Hospital
  • Federally Qualified Health Center
  • Hospital
  • Hospital-Based or CAH-Based Renal Dialysis Center (including satellite)
  • Physician or practitioner office
  • Rural Health Clinic
  • Skilled Nursing Facility

Warning: A patient’s home is not an authorized originating site, and independent renal dialysis facilities are not eligible either.

Reporting rules: Medicare telemedicine services come with specific reporting rules, too, so be sure you know the ones that apply to you. Here are a few to keep in mind:

  • Distant site practitioners should submit telehealth claims using place of service 02 (Telehealth).
  • Alaska and Hawaii participants in federal demonstration telemedicine programs are allowed to use asynchronous telecommunication systems. To show an asynchronous medical file came from one of those okayed participants, append modifier GQ (Via asynchronous telecommunications system) to the service code.
  • Distant site practitioners billing under the CAH Optional Payment Method submit institutional claims using modifier GT (Via interactive audio and video telecommunication systems).
  • Originating sites should report Q3014 (Telehealth originating site facility fee).

Resources: Keep Telemedicine Codes Close at Hand

You will find the AMA telemedicine codes in the printed CPT® manual, marked by a star and listed in an appendix. If you use online code search, telemedicine codes may be identified there, too. You also can choose a data file featuring telemedicine codes (AMA and/or Medicare) to integrate with your own existing systems so you can immediately identify eligible codes. Just be sure to update your resource each year so you have the current list of codes, and keep payer-specific rules in mind when you finalize your claim.

Sign Up For Daily Newsletter

Be keep up! Get the latest breaking news delivered straight to your inbox.
By signing up, you agree to our Terms of Use and acknowledge the data practices in our Privacy Policy. You may unsubscribe at any time.
Sudhir Singh July 23, 2018
Share this Article
Facebook Twitter Copy Link Print
Share
By Sudhir Singh
Follow:
Sudhir Singh is a marketer and blogger. He's passionate about marketing, disruptive technology, personal development, and inspiring others. He loves breakfast writing, traveling and exploring are his biggest passions. When he isn't working, I am with the book in front of my dog or on the dance floor.He also enjoys meeting new people and welcomes you to engage with him on social media on Instagram, Google +, LinkedIn, Twitter and Facebook. Keep Learning, Never be afraid to chase your dreams- "limits exist only in your stupid mind."
Previous Article Helping Your Aging Parents Plan For Their Financial Future
Next Article How are people successfully handling work-related injuries?

Stay Connected

1.5k Followers Like
4.5k Followers Follow
2.8k Followers Pin
136k Subscribers Subscribe

Latest News

11 ways nurses can care for patients during mental health crises
11 ways nurses can care for patients during mental health crises
Mental Health June 6, 2023
test
Essential Steps for Starting Your Journey as a Fitness Instructor
Fitness June 5, 2023
mimosa pudica
Health Benefits of Mimosa Pudica: The Marvel of Nature
News June 2, 2023
medical bills
Who is Responsible for Paying the Medical Bills After an Injury?
News June 1, 2023

You Might also Like

healthcare video marketing
MarketingSocial Media

How to Maintain a Successful YouTube Channel as a Healthcare Organization: Advantages of Video Marketing for your Medical Practice

November 9, 2022
Electronic Health Records
BusinesseHealthHospital AdministrationMedical Records

Top Benefits of Electronic Health Records for Psychiatrists and Psychologists

August 15, 2022
tips to design a health app
eHealth

How To Improve Patient Access Metrics

April 5, 2022
social media addiction is harming teenage mental health
eHealthMental HealthSocial Media

5 Ways Social Media Affects Teen Mental Health

April 4, 2022
//

We influence million of users and is the most authentic source of information on healthcare business and technology news.

Quick Links

  • About
  • Contact
  • Privacy
Subscribe

Subscribe to our newsletter to get our newest articles instantly!

Follow US

© 2008-2023 HealthWorks Collective. All Rights Reserved.

Welcome Back!

Sign in to your account

Lost your password?