Telemedicine Billing - CPT Codes
What Is a CPT Code for Telemedicine?
There is no doubt that the adoption of telemedicine is becoming more widespread throughout the United States. As it does so, some medical practitioners are having difficulty understanding reimbursement protocols.
Current Procedural Terminology (CPT) is a coding system developed by the American Medical Association (AMA) in 1966. Its purpose is to provide healthcare services with a consistent method for billing insurance companies. Here, we explain the basics of telemedicine CPT codes and their uses.
What are CPT Codes?
Telehealth CPT codes are an integral part of the medical billing process. They represent various medical procedures, such as evaluations, medical tests, and surgeries. Each procedure has its CPT code. Typically, each code is five numeric or alphanumeric digits long. For example:
- Speech and language therapy: 92507, 92508, 92521, 92522, 92523
- Physical therapy evaluation: 97161, 97162, 97163
- Office/outpatient visits for established patients: 99211, 99212, 99213, 99213, 99215
The protocol includes unique codes for each medical procedure, which means there are thousands of codes in the repertoire. Each indicates to the insurance company which procedures the practitioner wishes to be reimbursed for.
What Are CPT Codes Used for Telemedicine?
When CPT codes are used in telemedicine, they are modified so that the insurance providers know that the patient visit was a virtual one. The modifications include:
- Place of Service 02: The POS 02 code was first used in 2017 to show that telehealth services have been provided.
- GT Modifier: Although this modification remains in use in some situations, it has mainly been replaced by POS 02.
- 95 Modifier: This modification is added to indicate that real-time, interactive telemedicine services were provided.
- GQ Modifier: This modification is used by healthcare providers who use specific asynchronous telehealth programs in Hawaii or Alaska.
Knowing which codes to use for reimbursement has become essential with the exponential increase in virtual care throughout the medical industry.
As with any form of medical treatment that requires reimbursement, the correct code is needed when billing. Fortunately, the coding procedure is just as simple as standard billing procedures. The CPT codes themselves are very similar to existing codes.
Always remember to contact your payer beforehand to confirm what their telemedicine billing guidelines are.
Also, note that Medicare has previously required that patients live in HPSAs (Healthcare Professional Shortage Areas), meaning that originating site locations were limited to the following:
- Offices belonging to doctors or other clinical providers
- Critical access hospitals
- Rural health clinics
Nevertheless, most private payers are no longer subject to this restriction.
Reimbursement CPT Codes for Telemedicine?
The policies around telemedicine reimbursement can be confusing. As a result, some common misconceptions are that providers cannot be reimbursed for telemedicine appointments or that the rates for telemedicine reimbursement are reduced. These obstacles make telemedicine economically unattractive to physicians.
Many payers are required by law to reimburse telemedicine, and rates are often similar to in-person services. Some payers are residing in states that do not mandate reimbursement cover telemedicine regardless. This is because they save on the overall costs of Emergency Department preventions and benefit from higher effectiveness in managing chronic conditions. Quick Guide for Telemedicine Reimbursements
What Is a GT Modifier?
It was previously a requisite for providers to submit telehealth service claims with the appropriate service codes in addition to the telehealth GT modifiers (in the case of interactive audio and video telecommunications systems).
Since January 1, 2018, GT modifiers are only allowed institutional claims billed under CAH (Critical Access Hospital) Method II since institutional claims do not use POS codes.
Billing that has been initiated via other provider types will be rejected.
For certain regions, such as Alaska and Hawaii, GQ modifiers (i.e., in the case of asynchronous (delayed) telecommunications systems) are still required where applicable.