Understanding Telehealth Codes

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

• Telehealth: The physician or Other Qualified Health Care Professional (QHCP) uses an interactive audio and video telecommunications system, such as the Eyefinity EHR video telehealth feature, which permits real-time communication between the physician and/or QHCP and the patient at home. CPT range 99201–99215 billed with a 95 Modifier and Place of Service (POS) 02. (E/M level dependent upon current documentation requirements of History, Exam and Medical Decision Making.) For information about video telehealth, go to Conducting Video Telemedicine Exams.

• 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

• 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.

• 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.

• 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.

Other Payers

Most states have laws requiring that commercial payers provide some degree of coverage for telehealth, 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 telehealth 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 telehealth services.

• AOA Guide to Telehealth-based Care During COVID-19
• VSP Update on Optometry & Telemedicine During COVID-19
• CMS List of Telehealth Services