01/31/2022

Proper Coding for Telemedicine

What is proper coding for telemedicine visit? What needs to be documented for that code. Thanks

When billing for telemedicine services, it depends on how the services are provided to the patient:

• If a visit is conducted by audio only with no video communication, CPT codes 99441-99443 should be billed with POS code 11 for office services with either modifier -95 or -GT to designate telemedicine services

If a visit is conducted with audio & video capabilities, a new or established office E&M code can be billed (99202-99215) with POS code 11 for office services with either modifier -95 or -GT to designate telemedicine services

The rules can vary from insurance to insurance, but billing with an established E&M code with a telemedicine modifier is the most common way to be reimbursed for remote healthcare services since most providers have a way to interact with a patient in some method via video capabilities.

Starting in 2022, a new POS code was created that will be required to be reported by some Medicare Advantage and commercial plans. Instead of using POS code 11 for the office, POS 10 should be reported for patient’s receiving care while at home. If an insurance requires Telehealth services to be billed with POS 10 over 11, modifiers -95 or -GT do not need to be reported with the E&M code.