New billing codes have been made for COVID-19. Synapse has compiled the necessary information to help billers understand the new codes. Congress is now considering new laws and may relax these new rules over time or draft new codes. We will keep our clients updated. Thank you and stay safe.
Helpful information regarding COVID-19/Telehealth Coverage, and Billing Guidelines:
Two new HCPCS codes have been made for health providers to test patients for the Coronavirus. Providers using CDC 2019 novel Coronavirus real-time RT-PCR Diagnostic test panels may bill the tests using the code U0001.
The HCPCS code U0002 is used by laboratories and health facilities to bill Medicare and other insurers that choose to adopt the new code for the tests.
Code U0002 describes 2019-nCov coronavirus, SARS-Cov 2/2019-n Cov (Covid-19), by any technique many types or subtypes including all targets. Medicare will start accepting these codes by April 1, 2020, for dates of service on or after February 4, 2020.
Since 2018, beneficiaries are able to talk to their doctors without visiting their doctor’s office. The process is known as a virtual check-in.
Virtual Check-ins are for patients with established relationships with their doctors. They are allowed under the following conditions: the virtual check-in must not relate to a previous visit of seven days or a visit within the next 24 hours. Patients must verbally consent to start this process. The patient’s consent must be recorded on their medical record.
Some virtual check-ins may be covered by Medicare, but patients must still pay the coinsurances and deductibles. Doctors and certain practitioners may bill for visual check-in services from other communication devices.
Telephones use the HCPCS code G2012. Captured images or videos use the HCPCS code G2010. Medicare covers patient to doctor communication through online patient portals. These services are billed by using CPT codes 99421-99423.
Qualified non-physician health providers may also provide virtual check-ins with established patients. Codes G2061-G2063 were made to facilitate the billing of this process.
- G2061: The code is for an online assessment by a qualified non-physician health provider for an established patient of up to seven days with a cumulative time of 5-10 minutes.
- G2062: Same as G2061, but 11-20 minutes of medical consultative discussion and review.
- G2063: Same as G2061, but 21 minutes or more of medical consultative discussion and review.
HCPCS codes G2061-G2063 have coinsurance and deductible payments from Medicare.
Communication technology can be used by Medicare beneficiaries in rural areas in lieu of doctor visits. Medical services performed by using real-time audio and video communication is known as telehealth. Patients who receive services using real-time audio and video communication systems by Telehealth.
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Suggested Telehealth codes
99421–99423; G2061 – G2063
CPT® codes( 99421–99423) – and payment for – online digital evaluation and management (E/M) services
CPT® developed three new CPT® codes for use by physicians, physician assistants and advanced practice nurse practitioners performing brief, online E/M services via a secure platform
CMS is developing three new HCPCS codes for use by clinicians who do not have E/M within their scope of practice and clinicians who have E/M services in their scope of practice and will recognize these instead of the new CPT® codes 98970—98792
CMS is requiring, verbal, consent for communication-based technology services (CBTS)
This verbal consent is required annually and encompasses all CBTS, not a consent/service or consent for each provision of the service
The chart below does not include 98970—98972 because CMS has not assigned RVUs.
Suggested Telehealth codes
CMS developed two new codes for 2019 for virtual check-in and for reviewing an image or recording, “store and forward.” They are HCPCS codes G2010 and G2012.
CMS said it doesn’t consider these to be telehealth services, although they are using technology-based communication, they don’t need to meet the requirements of telehealth.
G2010 and G2012
Please note, Tricare requires HIPAA video conferencing. Audio only/telephone communication is not covered.
***As of March 17, 2020, President Trump has suspended HIPAA rules for video conferencing. Please continue to practice discretion as new updates are continuously coming in. Contact Synapse for help.
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Synchronous Telemedicine Services
Synchronous telemedicine services involve an interactive, electronic information exchange in at least two directions in the same time period.
Providers must bill using CPT or HCPCS codes with a GT modifier for distant site and Q3014 for an applicable originating site to distinguish telemedicine services. Also, Place of Service “POS 02” is to be reported in conjunction with the GT modifier. (Note: By coding and billing the GT modifier with a covered telemedicine procedure code, the distant site provider certifies that the beneficiary was present at an eligible originating site when the telemedicine service was furnished.)
Asynchronous Telemedicine Services
Asynchronous telemedicine services involve storing, forwarding and transmitting medical information on telemedicine encounters in one direction at a time.
Providers must bill using CPT or HCPCS codes with a GQ modifier.
Note: When submitting claims for telemedicine services, the originating site provider may indicate “Signature not required – distance telemedicine site” in the required Patient Signature field.
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The six codes describe assessment and management services conducted through telephone, internet, or electronic health record consultations. They are furnished when a patient’s treating physician or other qualified healthcare professional requests the opinion and/or treatment advice of a consulting physician or qualified healthcare professional with specific specialty expertise to assist with the diagnosis and/or management of the patient’s problem. This process negates the need for the patient to contact the consulting physician or qualified healthcare professional face-to-face.
For the consulting physician:
CPT 99446: Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified healthcare professional; 5-10 minutes of medical consultative discussion and review
CPT 99447: Same as 99446, but 11-20 minutes of medical consultative discussion and review
CPT 99448: Same as 99446, but 21-30 minutes of medical consultative discussion and review
CPT 99449: Same as 99446, but 31 minutes or more of medical consultative discussion and review
CPT 99451: Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician. It includes a written report to the patient’s treating/requesting physician or other qualified healthcare professional, 5 or more minutes of medical consultative time
For the treating physician:
CPT 99452: Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified healthcare professional, 30 minutes.
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Consultant codes 99446-99449, and 99451
- can be reported for new or established patients
- can be reported for a new or exacerbated problem
- are reported only by a consultant when requested by another physician/QHP
- cannot be reported more than once per seven days for the same patient
- are reported based on cumulative time spent, even if that time occurs on subsequent days
- are not reported if a transfer of care or request for a face-to-face consult occurs as a result of the consultation within the next 14 days
- are not reported if the patient was seen by the consultant within the past 14 days
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All of the information presented contains codes and other useful information to help billers and medical practices navigate through the pandemic.
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