As of March 6, 2020, and for the duration of the COVID-19 Public Health Emergency Medicare and other commercial payors will now pay for office, hospital, and other visits furnished via telehealth across the country and patient’s places of residence. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients.
Medicare beneficiaries will be able to receive a specific set of services through telehealth including evaluation and management visits (common office visits), mental health counseling and preventive health screenings. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital which puts themselves and others at risk.
There are three main types of virtual services physicians and other professionals can provide to Medicare beneficiaries. Commercial carriers generally follow Medicare guidelines.
1) Medicare telehealth visits These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
2) Virtual check-ins Bill Code G2012 – Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
G2010– Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment.
3) E-visits
99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes. 99422: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes
99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech-language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes: G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes. G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.
Use POS Code: TH02
User Modifier 95 or GT
95 – Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified healthcare professional and a patient who is located at a distant site from the physician or other qualified healthcare professional
GT– service was rendered via synchronous telecommunication.
Below are some payor specific information on modifiers:
Aetna: they will accept either -GT or -95
Cigna: modifier -95
United Healthcare: modifier -GT
Medicare: modifier -GT
Anthem BCBS (California, Georgia, Missouri, Colorado, Indiana, Connecticut, NewYork-Empire): modifier -GT BCBS MA: either -GT or -95
Compsych: no modifier required
Magellan: either -GT or -95
Source: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet