InSync Healthcare Solutions
October 2022 EHR and Practice Management Updates
Keeping up with constantly changing industry standards and innovations is a challenging task for behavioral health practices today. This is...
Updated Aug, 7 2020
We've added labs for COVID-19. Additional medical billing codes (86602-86804) are qualitative or semiquantitative immunoassays. For more information on the additional CPT codes please refer to the AMA CPT document.
Given the current emergency measures being taken to control COVID-19, many providers are introducing telemedicine services to reduce the risk of exposure to themselves and their patients. The recently lifted Medicare telemedicine restrictions are also helping providers extend this option to more senior patients.
If you're now dealing with a large influx of telemedicine service claims, we've put together information on telemedicine CPT codes as a resource for you to keep and use. Just bookmark this page (ctrl+d on your keyboard) and come back to it anytime you need them.
Type of Service |
Description |
HCPCS/CPT Code |
Patient Relationship with Provider |
Covid-19 Labs |
Immunology - Available for reporting April 10, 2020. Contact 3rd party provider for guidelines regarding reimbursement. |
86328 - Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) 86769 - Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) |
|
Medicare Telemedicine Visits |
A visit with a provider that uses a telecommunication system between the provider and patient. |
Common telemedicine services:
|
For new* or established patients. *To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency. |
Virtual Check-In |
A brief (5-10 minutes) check-in with a practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed.A remote evaluation of recorded video an/or images submitted by an established patient. |
|
For established patients. |
E-Visit With ASsessment |
Online assessment by a qualified non-physician healthcare professional |
|
For established patients. |
E-Visits |
A communication between a patient and their provider through an online patient portal. |
|
For established patients. |
Telephone Services |
Telephone evaluation and management service by a physician or other qualified healthcare professional. |
|
For established patients. |
HCPCS LEVEL II CODES |
|||
telemedicine services |
Follow-up Inpatient Consultation via Telehealth |
G0406-G0408 |
For established patients. |
telemedicine services |
Telehealth Consultation, Emergency Department |
G0425-G0427 |
For new patients. |
telemedicine services |
Telehealth Consultation, Critical Care |
G0508, G0509 |
For new and established patients. |
Claim Changes for Telemedicine
As a reaction to the COVID-19 outbreak, laws have been changing at rapid speed. Restrictions on seniors for Medicare are relaxed and the department of Health and Human Services (HHS) has allowed providers to practice across state lines without additional licensing. Be sure to check your state specific policies.
Medicare licensing
With the declaration of a national emergency by the President, the Secretary issued a 1135 Waiver for “requirements that physicians or other health care professionals hold licenses in the state in which they provide services if they have an equivalent license from another state.” This is a brand new change and CMS has yet to even provide guidance on how this will be implemented.
Coronavirus Aid Relief, and Economic Security Act
The $2 trillion dollar "Cares Act" has been signed into law and replaces language placed into law by HR 6074. Any patient now qualifies for telehealth and qualified providers are no longer exclusive to existing patients. Additionally, they have included the ability to use a telephone as long as it has audio and visual capabilities. Although not permanent, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) will be allowed to act as distant site providers for reimbursable telehealth services under Medicare with no distance requirements.
Additional info:
-
Waived Dialysis once a month face to face encounter requirement
-
Emergency Period - Waived Hospice face to face admissions
-
Emergency Period – Home Health – Remote Patient Monitoring
-
$27 billion to the Public Health and Social Services Emergency Fund to combat COVID-19 with “telehealth access” cited as one of the tools to be used.
-
$1 billion to Indian Health Services to respond to COVID-19 including among other things using telehealth and other information technology upgrades.
-
$180 million transferred to the Health Resources and Services Administration – Rural Health to carry out among other things telehealth and rural health activities.
To stay up to date on the rapidly changing healthcare system in the United States please subscribe to our blog. We are diligently reporting on all the changes as they happen.
National Alzheimer's Disease Month Dementia Dilemmas
6.2 million Americans are currently living with Alzheimer’s. That number’s projected to double within the next three decades. National Alzheimer's...
Movember Men’s Health Awareness Month
Movember’s founders and participants have discovered a whimsical way to impact the most devastating human crisis: suicide. It’s a fascinating way to...