Telehealth Billing Guidelines for Orthopedics

1. Telehealth Billing Guidelines for Orthopedics Medical Billers and Coders

2. During the COVID-19 public health emergency, reimbursements for telehealth continue to evolve. The federal government, state Medicaid programs and private insurers have expanded coverage for virtual health care services. More Medicare Fee-for-Service (FFS) services are billable as telehealth during the COVID-19 public health emergency. In this blog, we shared telehealth billing guidelines for medical billing specialty orthopedics. This article will answer basic telehealth billing questions like: How should I bill telehealth? How to bill for Medicare telehealth visits? Which procedure codes and modifiers should I use? What are the restrictions I should watch out for?

3. Video Visit Billing The CPT codes for virtual video visit billing are 99201-99215. CPT 99201-99205 are for new patients while 99211-99215 are for established patients. We recommend limiting televisits to established patients. Please note that American Medical Association CPT rules may differ from CMS guidelines. It is important to know which guidelines your commercial carrier is following. The documentation for these encounters is the same as in-person requirements (except the exam). For example, code 99213 requires either: Expanded problem-focused history and low complexity medical decision-making, or 15 minutes spent face-to-face with the patient if coding based on time.

4. Telephone Visit Billing Telephone services without face-to-face discussion are not frequently reimbursed. These codes are not billable if the call results in the patient coming in for a face-to-face service within the next 24 hours or the next available urgent visit. Medicare won’t cover telephone billing codes (99441: 5-10 minutes, 99442: 11-20 minutes, and 99443: 21-30 minutes). Telephone calls are also not billable if they refer to an E/M service performed within the last seven days. Coverage of telephone calls is not consistent so it is important to check the coverage and payment for various payers.  

5. Medicare Telehealth Visits A telehealth visit is defined as a visit with a provider that uses telecommunication systems between a provider and a patient. The HCPCS/CPT codes for common telehealth services include: CPT 99201-99215 (Office or other outpatient visits); CPT G0425-G0427 (Telehealth consultations, emergency department or initial patient); CPT G0406-G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or skilled nursing facilities) These visits are designated for new or established patients. HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency. Please note that this billing information is taken from CMS Medicare Telemedicine Healthcare Provider Fact Sheet which describes the types of virtual services for Medicare Beneficiaries. Refer to CMS for a complete list of telehealth services payable under the Medicare Physician Fee Schedule.

6. Virtual Check-in Virtual check-in is defined as a brief (5-10 minutes) check-in with your practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient. The HCPCS/CPT codes for this type of visit include HCPCS code G2012; and HCPCS code G2010. These virtual check-in codes are used with established patients. E-visits This type of visit is defined as communication between a patient and their provider through an online patient portal. The HCPCS/CPT codes for this type of visit include CPT 99421, 99422, 99423, G2061, G2062, G2063. These e-visits codes are used with established patients.

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