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Best Telemedicine Billing Tips You Need to Know


Do You Know Everything You Need To Know About Billing for Telemedicine?

Billing for telemedicine is complex, and new laws emerge every day. Add the differences between payers and the many codes involved, and there is far too much gray area. Read on for what you need to know about how to bill for telemedicine visits, tips to make the process go more smoothly, and the rules and regulations currently in place.  

The Impact of Telehealth on Medical Billing

In 2000, the Department of Health and Human Services launched the Medicare, Medicaid and Benefits Improvement and Protection Act, which expanded coverage for telehealth services to include:

  • Office telemedicine visits
  • Psychotherapy (evaluative and management)
  • Consultations and more.

Since then, the list has expanded to include nursing care and emergency telemedicine visits. 

Following COVID-19’s arrival, telehealth is a way of life for many people. Additionally, medical billing had to transform to stay in line with the technology used for telemedicine.

Medical billers have had to learn:

  • Medicare’s regulations regarding telehealth.
  • The laws in their state.
  • How to bill patients correctly for telehealth services.
  • How to determine the best telehealth service for specific patient needs.
  • How to bill private payers.
  • What are current reimbursement rates? ($99.45)

That can be a lot to take in, but this article serves to help you understand what you need to know about telemedicine billing. 

Telemedicine Billing Requirements Your Medical Practice Should Be Aware Of

Telemedicine billing rules and regulations differ from typical medical billing. All of the major insurers cover telemedicine. Still, experts recommend calling the payer to verify coverage before the appointment takes place because coverage varies among policies and providers. During your call, verify which services are covered and inquire about restrictions.

Many major insurance providers require physicians and nurse practitioners to use the designated CPT codes and GT modifiers for billing purposes. The most often used telemedicine codes are listed below, but you can request a list of covered codes from each payer with whom you work to ensure you have all the codes your practice needs.

New Telemedicine Rules Are Emerging Every day

Ensure that your organization stays on top of the rules and regulations which apply to you. For instance, when determining the level of service that you provided, you are limited to billing for face-to-face time with a patient or caregiver.

Telemedicine Billing Tips For Providers

The below tips describe the best ways to bill for telemedicine and keep in mind when doing so.

  • Integrate medical billing software with your telehealth software.

By integrating your medical billing software with your telehealth software, you can save you and your staff a massive headache while learning the new telemedicine codes and adapting to using these new tools.  

  • Verify beforehand that the patient’s insurance covers telemedicine.

Telemedicine rules and regulations are different for each payer. Ensure your patient’s insurance covers telemedicine before the appointment.

  • Know common telemedicine codes.

Codes are required when billing for telehealth visits. The most commonly used telemedicine codes include:

  • Behavioral change interventions: 99406-99408
  • Established patient visits: 99212-99215
  • New patient visits: 99201-99205
  • Consultations: 99241-99245

Additionally, there are codes for remote physiological monitoring.

Medicare has been expanding the scope of telemedicine services for which they will pay.

The following codes are for Medicare Fee-for-Service Providers:

  • HCPCS codes G0406-G0408: Use this code for inpatient telehealth consultation follow-ups for beneficiaries in hospitals and SNFs.
  • CPT codes 96150-96154: Use this code for behavioral health interventions and assessments for groups and individuals.
  • HCPCS codes G0425-G0427: This code is for initial inpatient or emergency department telehealth consultations.
  • CPT codes 90836-90838 and 90832-90834: These codes are for psychotherapy telemedicine appointments for individuals.

Please note that Medicare will only pay for telemedicine services during which the patient was present and “used an interactive audio/video telecommunication system to communicate with a remote practitioner.” know more about CPT codes used for telemedicine

  • Know the telemedicine guidelines for each payer.

For example, you must understand how to bill for video consultations, which can be added to standard CPT codes by “adding the 95 modifiers.” However, remember that the 95 modifier is not for asynchronous telemedicine encounters, like ultrasound studies or radiograph studies.

  • Decide how to handle telemedicine charges.

For example, when billing for a telehealth visit with a Medicaid recipient, if the patient was on-site at a hosting facility (opposed to being at home), you could be charged a facility fee. Decide in advance how you will handle telemedicine charges will ensure there are fewer surprises.

  • Inquire with the payer about what CPT codes are eligible for billing telemedicine.

If there are codes that your practice needs that are not listed above, you can contact the payers with whom you work for a list of telemedicine codes that they accept.

  • Store data on a centralized repository to boost interoperability.

Using a centralized repository allows your data from your telehealth software and other software to combine, ensuring a seamless workflow.

  • Know how to bill a facility fee.

Always verify that a payer covers facility fees before billing for them. The code for facility fees is HCPCS code Q3014.

  • Maintain documentation integrity.

First, ensure that you document every telemedicine interaction. In addition, when using peripherals, such as thermometers or oxygen saturation monitors, include them in your coding. Without adding them, you might not show cause to “support the need for the specific CPT code you use.”

  • Hire an experienced telehealth and telemedicine billing company.

When you work with a company with experience in medical coding and billing, you ensure that you are paid for your telehealth services and can expand your clinic’s reach through telemedicine without the hassle of coding. Top telehealth software comparison chart

Maximize Your Telemedicine Services with CaretimeMD

CaretimeMD allows medical practices to spend more time on patient care by enabling providers to integrate their telehealth software and their billing software. The integration saves time, and the software makes billing for telemedicine a breeze. 

The takeaway is to ensure you know what you need to know about billing for telemedicine services, including commonly used codes and the regulations of each payer with which you do business. The tools to link your telemedicine software and your billing software also create a seamless workflow. Checkout Pricing here