Understanding Telehealth Codes

CMS recognizes the following CPT codes for telemedicine services. The information below is based on Medicare’s definition and available billing guidance:

  1. Store and Forward: A remote evaluation of recorded video and/or images submitted by an established patient, including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M services provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. HCPCS code G2010.
  2. Virtual Check-In: Brief communication by a physician or other qualified health care professional (QHCP), via telephone or other telecommunications device, 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 net 24 hours or soonest available appointment; 5-10 minutes of medical discussion. HCPCS code G2012.
  3. Telephone E/M (non-Medicare): Telephone evaluation and management service by a physician or QHCP who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days or leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
    • 99441: 5-10 minutes of medical discussion
    • 99442: 11-20 minutes of medical discussion
    • 99443: 21-30 minutes of medical discussion
  4. Digital E/M: Patient initiated online evaluation and management conducted via a patient portal. Practitioners who may independently bill Medicare for evaluation and management visits (e.g., physicians, nurse practitioners, physician assistants) can bill the following codes:
    • 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.
  5. Telehealth: The physician or Other Qualified Health Care Professional (QHCP) must use an interactive audio and video telecommunications system that permits real-time communication between the physician and/or QHCP and the patient at home. CPT range 99201-99215 billed with Place of Service (POS) 02. (E/M level dependent upon current documentation requirements of History, Exam and Medical Decision Making.)

Different insurances may have different requirements for how the Place of Service (POS) should be documented as well as what modifiers need to be included. To avoid having your claims rejected, make sure to check the individual requirements of the insurance you're billing.

For VSP requirements, please see the VSP Vision Care section of VSP Update on Optometry & Telemedicine During COVID-19.

Other Payers

Most states have laws requiring that commercial payers provide some degree of coverage for telemedicine, but only a few have payment parity, which means the amount being paid by commercial payers, as well as the approach to providing such coverage, continues to be variable. Due to the variation in how commercial/private payers reimburse for telemedicine services, we recommend that you review your payer contracts or contact your payers to better understand how you might bill for such services.

Additional Resources

The following resources will help you understand the codes you can use to bill for telemedicine services.