Telehealth Crosswalk
Revised May 25, 2021
AFMC will continue to update this document as new information is identified. Please check back often to ensure you have the most up-to-date information.
This document was developed in collaboration with Dr. Randy Walker’s office and should be used for reference purposes only.
Please refer to the payer for confirmation of covered services.
Go directly to a payer
Blue Cross Blue Shield – Arkansas
Download the condensed Telehealth Crosswalk PDF
Medicare
Revised May 25, 2021
CMS Medicare Telemedicine Health Care Provider Fact Sheet – March 17, 2020
Medicare Telehealth Frequently Asked Questions (FAQs) – January 7, 2021
MLN Booklet – Telehealth Services – March 2020
Medicare Telehealth Benefit Video – Updated May 8, 2020: Medicare Coverage and Payment of Virtual Services
CMS COVID-19 FAQs on Medicare Fee-for-Service (FFS) Billing – Updated May 6, 2021
Medicare Telehealth Visits
Provider Type
Physicians
Nurse practitioners
Physician assistants
Nurse midwives
Certified nurse anesthetists
Clinical psychologists
Clinical social worker
Registered dietitians
Nutrition professionals
What is the Service?
A visit with a provider who uses real-time telecommunication systems between a provider and a patient (telecommunication must use audio and visual capabilities)
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
Common telehealth services include:
99201-99215 (office or other outpatient visits)
– 95 Modifier or CS Modifier**
– POS 02 OR the POS you would typically report for a face-to-face visit (i.e., POS 11)
G0425-G0427 (telehealth consultations, emergency department or initial inpatient)
G0406-G0408 (follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs)
For a complete list of covered telehealth services: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
Requirements
For new* or established patients
Interactive Telecommunications System – Telehealth services provided via a real-time audio-video
*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 (coinsurance and deductible would generally apply; however, the HHS OIG is providing flexibility for health care providers to reduce or waive cost-sharing for telehealth visits paid by federal health care programs.)
**New guidance issued of 04/07/2020 – utilize CS modifier on applicable claim lines to identify the service as subject to the cost-sharing waiver for COVID-19 testing related services and should NOT charge Medicare patients any coinsurance and/or deductible
Special Instructions
POS 02 OR POS you would typically report for a face-to-face visit (i.e., POS 11)
Modifier 95
Virtual Check-in
Provider Type
Physician and other qualified healthcare professionals (LCSW, clinical psychologist, PT, OT, speech-language pathologist)
What is the Service?
A brief (5-10 minutes) check-in with your practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed.
OR
A remote evaluation of recorded video and/or images submitted by a new or established patient.
Virtual check-ins can be conducted with a broader range of communication methods, unlike Medicare telehealth visits, which require audio and visual capabilities for real-time communication.
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
HCPCS 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.
HCPCS code 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.
CMS revised to include new and established patients
Requirements
For established or existing patients
– Patient must initiate
– Communication is not related to a medical visit within the previous 7 days or lead to a medical visit within the next 24 hours
– Patient must verbally consent to receive virtual check-in
– Virtual check-ins can be conducted with a broader range of communication methods (i.e., telephone, audio/video, secure text messaging, email, or use of patient portal)
*Coinsurance and deductible would generally apply; however, the HHS OIG is providing flexibility for health care providers to reduce or waive cost-sharing for telehealth visits paid by federal health care programs.
Special Instructions
e-Visit
Provider Type
Physician or other qualified healthcare professional (Nurse practitioner)
What is the Service?
Online Digital Evaluation and Management
Non-face-to-face, patient-initiated communication between a patient and their provider through an online patient portal
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
99421 (5-10 minutes)
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 (11-20 minutes)
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 (>21 minutes)
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
G2061* (5-10 minutes)
Qualified non-physician health care professional online assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes
G2062* (11-20 minutes)
Qualified non-physician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11–20 minutes
G2063* (>21 minutes)
Qualified non-physician qualified health care professional assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes.
Requirements
– For established patients**
– Service needs to be initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation.
– Communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hour (or soonest appointment available).
– The patient must verbally consent to receive virtual check-in services.
**The Medicare coinsurance and deductible would generally apply to these services.
Special Instructions
*Clinicians who may not independently bill for evaluation and management visits (physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can utilize the G-codes to provide these e-visits and bill.
Telephone Services
Provider Type
Qualified non-physician health care professional
What is the Service?
Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent or guardian
Not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment
HCPCS / CPT Code
Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10; 11-20; or 21-30 minutes of medical discussion
98966 (5-10 minutes)
98967 (11-20 minutes)
98968 (>21 minutes)
POS that would have been used had the service occurred in person
Modifier 95
Requirements
Requires telephone
Established patient, parent or guardian
Patient-initiated
Cannot be related to a medical visit within the previous 7 days or lead to a visit within 24 hours or soonest available appointment
5-10; 11-20; or 21-30 minutes of medical discussion
Special Instructions
Telephone Only Services
Provider Type
MD/ANP
What is the Service?
Telephone evaluation and management service by a physician or other qualified health care professional 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 nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment
HCPCS / CPT Code
Telephone evaluation and management service by a physician or other qualified health care professional 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 nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10; 11-20; or 20-30 minutes of medical discussion.
99441 (5-10 minutes)
99442 (11-20 minutes)
99443 (20-30 minutes)
POS that would have been used had the service occurred in person
Modifier 95
Requirements
Requires telephone
New or established patient, parent or guardian
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
Special Instructions
Annual Wellness Visit, first visit
Provider Type
MD/ANP
What is the Service?
Annual Wellness Visit, Includes a personalized Prevention Plan of Service (PPPS), first visit
– Covered only once, within 12 months of Part B enrollment
– Patient pays nothing
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
G0438
Annual Wellness Visit, includes a personalized prevention plan of service (PPPS) first visit (review of medical and social health history, and preventive services education)
Requirements
Must include personalized prevention plan of services
– Must utilize either interactive audio and video or audio only telecommunication that permits real-time communication (4/30/2020)
Special Instructions
Should include all required aspects of the visit.
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Annual Wellness Visit
Provider Type
MD/ANP
What is the Service?
Annual Wellness Visit, subsequent visit
*Covered once every 12 months
*Patient pays nothing
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
HCPCS code G0439
Annual Wellness Visit, includes a health risk assessment and personalized prevention plan of service (PPPS) subsequent visit
Requirements
Must include personalized prevention plan of services
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Transitional Care Management
Provider Type
MD/ANP (if legally authorized and qualified to provide the services in the state in which they are furnished – CNMs/CNSs/PAs)
What is the Service?
Transitional Care Management Services with Moderate Complexity Decision Making
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
99495
Transitional care management services with moderate medical decision complexity (face-to-face visit within 14 days of discharge)
Requirements
Within 14 days of discharge
May be provided via telehealth
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Transitional Care Management
Provider Type
MD/ANP/ (if legally authorized and qualified to provide the services in the State in which they are furnished – CNMs/CNSs/PAs)
What is the Service?
Transitional Care Management Services with High Medical Decision Making
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
99496
Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge)
Requirements
Within 7 days of discharge
May be provided via telehealth
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Advanced Care Planning
Provider Type
MD/ANP
What is the Service?
Advanced Care Planning
(Can be done at the time of an Annual Wellness Visit)
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
99497
Advance Care Planning, first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate
99498
Advance Care Planning, additional 30 minutes
Requirements
– First 30 minutes
– Additional 30 minutes
(Note: No place of service code limitations.)
May be provided via telehealth
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Nursing Facility Visits
Provider Type
MD/ANP
What is the Service?
Subsequent Nursing Facility Care Services
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
99307-99310
Subsequent nursing facility care, per day, for the evaluation and management of a patient,
Requirements
Frequency restrictions removed via CMS-1744-IFC
Provider should review code requirements for the inclusion of 2 of 3 key components and time spent at bedside and on the patient’s facility floor or unit.
Must use interactive audio and video telecommunications
Limitation of 1 telehealth visit every 30 days
Special Instructions
Telehealth DSM Training
Provider Type
CDE
What is the Service?
Diabetes Self-Management Training Services
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
HCPCS code G0108 -G0109
Individual and group diabetes self-management training services, with a minimum of 1 hour of in-person instruction furnished in the initial year training period to ensure effective injection training
Requirements
Minimum of 1 hour in-person instruction
May be completed via audio-only
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Behavior Assessment
Provider Type
LCSW
What is the Service?
Behavior Assessments & Intervention
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
96150 – 96154
Individual and group health and behavior assessment and intervention
Requirements
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Individual Psychotherapy
Provider Type
LCSW
What is the Service?
Individual Psychotherapy
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
90832
Individual psychotherapy
90833 w/E&M
Individual psychotherapy
90834
Individual psychotherapy
90836 w/E&M
Individual psychotherapy
90837
Individual psychotherapy
90838 w/E&M
Individual psychotherapy
Requirements
90832 (30 minutes)
90833 (30 minutes)
90834 (45 minutes)
90836 (45 minutes)
90837 (60 minutes)
90838 (60 minutes)
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Psychotherapy for Crisis
Provider Type
LCSW
What is the Service?
Psychotherapy for Crisis
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
90839
Psychotherapy for crisis
90840
Psychotherapy for crisis
Requirements
Life Threatening/Complex Patient is in High Distress
90839 (60 minutes)
90840 (additional 30 minutes)
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Individual & Group MNT
Provider Type
CDE
What is the Service?
Individual and Group Medical Nutrition Therapy
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
HCPCS code G0270
Individual and group medical nutrition therapy
97802
Individual and group medical nutrition therapy
97803
Individual and group medical nutrition therapy
97804
Individual and group medical nutrition therapy
Requirements
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Behavioral Therapy for Cardiovascular Disease
Provider Type
CDE
What is the Service?
Intensive Behavioral Therapy for Cardiovascular Disease
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
HCPCS code G0446
Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
Requirements
Annual, 15 minutes
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Behavioral Counseling for Obesity
Provider Type
CDE
What is the Service?
Behavioral Counseling for Obesity
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
HCPCS code G0447
Face-to-face behavioral counseling for obesity, 15 minutes
Requirements
15 minutes
May be completed via audio-only
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Smoking Cessation Services
Provider Type
– MD/ANP
– LCSW
What is the Service?
Smoking Cessation Counseling
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
99406
Smoking cessation services
99407
Smoking cessation services
Requirements
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Alcohol and/or Substance Abuse Services
Provider Type
– MD/ANP
– LCSW
What is the Service?
Alcohol and/or Substance Abuse Counseling
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
HCPCS code G0396
Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services
HCPCS code G0397
Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services
Requirements
Structed Assessment & Intervention Services
May be completed via audio-only
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Annual Alcohol Misuse Screening
Provider Type
– MD/ANP
– LCSW
What is the Service?
Annual Alcohol Misuse Screening
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
HCPCS code G0442
Annual alcohol misuse screening, 15 minutes
Requirements
15 minutes minimum
May be completed via audio-only
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Behavioral Counseling for Alcohol Misuse
Provider Type
– MD/ANP
– LCSW
What is the Service?
Behavioral Counseling for Alcohol Misuse
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
HCPCS code G0443
Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
Requirements
Face-to-face, 15 minutes
May be completed via audio-only
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Annual Depression Screening
Provider Type
– MD/ANP
– LCSW
What is the Service?
Annual Depression Screening
*These services covered through the end of the Public Health Emergency (PHE)
HCPCS / CPT Code
HCPCS code G0444
Annual depression screening, 15 minutes
Requirements
15 minutes
May be completed via audio-only
Special Instructions
For Additional Information reference the MLN Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Medicaid Requirement
Revised May 25, 2021
DHS’s Response to COVID-19 for Providers – Reviewed April 20, 2021
DMS-09 – Guidance on HIPAA during the COVID-19 Public Health Emergency – March 23, 2020
Emergency COVID-19 Response Manual – April 1, 2021
Telemedicine
Provider Type
Physician
APRN
What Is The Service?
Generally, a provider must have an established relationship with a patient before utilizing telemedicine to treat a patient. See Medicaid Provider Manual § 105.190. However, DMS has the authority to relax this requirement in case of an emergency. Pursuant to Executive Order 20-05 and as allowed under current Medicaid policy, DMS is lifting the requirement to have an established professional relationship before utilizing telemedicine for physicians and APRN through December 31, 2021. Reference the Emergency COVID-19 Response Manual released April 1, 2021.
HCPCS / CPT Code
– E&M Code AND
– “GT” Modifier AND
– Place of Service “02”
Medicaid: https://afmc.org/wp-content/uploads/2020/03/Memorandum-DMS-01-physician-telemedicine.pdf
Requirements
DMS has lifted the requirement to have an established professional relationship before utilizing telemedicine for physicians under the following conditions for the duration of the emergency declaration:
– The physician providing telehealth services must have access to a patient’s personal health record maintained by a physician.
– The telemedicine service may be provided by any technology deemed appropriate, including telephone, but it must be provided in real time (cannot be delayed communication).
– Physicians may use telemedicine to diagnose, treat, and, when clinically appropriate, prescribe a non-controlled drug to the patient.
Special Instructions
Include:
– E&M Code
– GT Modifier
– POS 02
Virtual Check-in
Provider Type
Clinician who can bill primary care services
What is the Service?
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report E&M 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. Typically, 5-10 minutes of medical discussion.
HCPCS / CPT Code
G2012
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report E&M 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. Typically, 5-10 minutes of medical discussion.
Requirements
The physician providing telehealth services must have access to a patient’s personal health record maintained by a physician.
The telemedicine service may be provided by any technology deemed appropriate, including telephone, but it must be provided in real time (cannot be delayed communication).
Physicians may use telemedicine to diagnose, treat, and, when clinically appropriate, prescribe a non-controlled drug to the patient.
Can be any real-time audio (telephone), or “2-way audio interactions that are enhanced with video or other kinds of data transmission.”
Available for established patients only
To be used for:
– Any chronic patient who needs to be assessed as to whether an office visit is needed.
– Patients being treated for opioid and other substance-use disorders.
Nurse or other staff member cannot provide this service. It must be a clinician who can bill primary care services.
If an E&M service is provided within the defined time frames, then the telehealth visit is bundled with that E&M service. It would be considered pre- or post-visit time and not separately billable.
No geographic location restrictions for the patient.
Communication must be HIPAA compliant.
Medicaid is opening the virtual check-in for 60 days. The code can be extended as required to address the public health emergency
Special Instructions
Clinician who can bill primary care services
Arkansas Blue Cross Blue Shield and Health Advantage
(Verify Self-Funded Coverage with Payer)
Updated May 25, 2021
Existing Telehealth Policy 2015034
Updated Nov. 2, 2020
Provider Type
MD/ANP/DO/PA
What is the Service?
The health care professional at the distant site must submit claims for telemedicine services using HCPCS or CPT Code for the professional service delivered, along with telemedicine modifier GT via interactive audio and video telecommunications systems or 95 synchronous telemedicine services rendered via real time interactive audio and video telecommunications
HCPCS / CPT Code
99201 or
99202 or
99203 or
99204 or
99211 or
99212 or
99213 or
99214
AND
GT modifier or
95 modifier or
CS Modifier*
AND
POS 02
Requirements
Telemedicine or telephonic communication may be used to establish a relationship with provider and maintain the relationship
For coverage information:
– Contact your BlueCross BlueShield provider services representative
– Review payers website information
– Review Telehealth policy
Requirements noted under current Telehealth Policy 2015034: https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2015034#lblCpt
Special Instructions
Claim must include E&M code AND modifier AND POS 02
*Any COVID-19 evaluation visit should include “CS” modifier. Visit may include the following screenings:
– 87635-COVID19 (RT-PCR test)
– 87804- Influenza
– 86710– Influenza
– 87880- Streptococcus
*Providers’ News June 2020 – See page 9
September 2020 – UPDATED – COVID-19 Testing Coverage – Page 4
Telephone-based Visit
Updated Nov. 2, 2020
Provider Type
In-network behavioral health professionals
Psychologist
LCSW
Licensed Professional Counselors.
What is the Service?
Arkansas Blue Cross Blue Shield and Health Advantage will provide payment for any in-network provider to visit by telephone with patients who are seeking advice or counsel on either physical or mental health needs.
In addition to creating this entirely new, temporary benefit for our fully insured members, Arkansas Blue Cross Blue Shield and Health Advantage will also waive all co-pays, coinsurance and deductibles for these new telephone-based benefits.
HCPCS / CPT Code
POS 02 or POS 11 or POS 12
99441 Telephone; 5-10 minutes
Telephone evaluation and management service by a qualified health care professional 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 nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
99442 Telephone; 11-20 minutes
Telephone evaluation and management service by a qualified health care professional 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 nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.
99443 Telephone; 21-30 minutes
Telephone evaluation and management service by a qualified health care professional 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 nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion.
Requirements
For coverage information:
– Contact your BlueCross BlueShield provider services representative
– Review payers website information
– Review Telehealth policy
Special Instructions
E/M code and POS 02 or 11 or 12
Online Digital Evaluation & Management Services
Updated June 5, 2020
Provider Type
MD/ANP
What is the Service?
A communication between a patient and their provider through an online patient portal.
HCPCS / CPT Code
99421 (5-10 minutes) over 7 days
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 (11-20 minutes) over 7 days
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 (<21 minutes) over 7 days
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
Requirements
For coverage information:
– Contact your BlueCross BlueShield provider services representative
– Review payers website information
– Review Telehealth policy
Requirements noted under current Telehealth Policy 2015034: https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2015034#lblCpt
Special Instructions
Ambetter/QualChoice
Revised May 25, 2021
Telehealth Services During COVID-19 Outbreak – March 23, 2020
Quality Results News and Updates for Providers – July 16, 2020
Provider Quick Alert – October 21, 2020
Telemedicine Payment Policy
Provider Type
MD/APRN
What is the Service?
Telehealth services are effective for the duration of the COVID-19 emergency
A visit with a provider that uses telecommunication systems between a provider and a patient
Established patient unless seen by a referral healthcare professional or an on-call healthcare professional, or in an emergency situation where the life or health of the patient is in danger
Any services that can be delivered virtually will be eligible for telehealth coverage.
HCPCS / CPT Code
99201-99205
99211-99215
G2010 and G2012
AND
POS 02
Modifier 95 or GT
Requirements
For additional clarification contact your QualChoice Provider Relations Representative.
Special Instructions
Non Face-To-Face Services: Telephonic Only
Revised Nov. 2, 2020
Provider Type
Qualified healthcare professional
What Is The Service?
Telephone-only services have historically not been covered but will now be covered through January 21, 2021. For more information regarding telephone-only visits, please see medical policy BI063.
HCPCS / CPT Code
Telephonic services (99441-99443)
Requirements
For additional clarification contact your QualChoice Provider Relations Representative.
Special Instructions
Aetna Commercial
Updated May 25, 2021
COVID-19: Provider FAQs and Resources – Updated April 14, 2021
COVID-19: Billing and coding FAQs – Updated March 29, 2021
COVID-19: Telemedicine FAQs – How does Aetna work with providers delivering telemedicine – Updated Aprl 14, 2021
Aetna’s telemedicine policy is available on the Availity portal
Existing Telemedicine Policy
Revised Nov. 2, 2020
Provider Type
MD/ANP
What is the Service?
A visit with a provider who uses telecommunication systems between a provider and a patient
HCPCS / CPT Code
99201-99205
99211-99215
Requirements
For additional information and current COVID-19 policy details contact Aetna provider service representative.
Special Instructions
Online Assessment
Provider Type
Non-physician Health Care Professional
What is the Service?
Qualified non-physician health care professional online assessment, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes; 11 – 20 minutes; or 21 or more minutes
Qualified non-physician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10; 11-20; or 21 or more minutes
HCPCS / CPT Code
Qualified non-physician health care professional online assessment, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes; 11 – 20 minutes; or 21 or more minutes
G2061 (5-10 minutes)
G2062 (11-20 minutes)
G2063 (>21 minutes)
Qualified non-physician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10; 11-20; or 21 or more minutes
98970 (5-10 minutes)
98971 (11-20 minutes)
98972 (>21 minutes)
Requirements
For additional information and current COVID-19 policy details contact Aetna provider service representative.
Special Instructions
Additional information refer to Aetna’s telehealth policy
Telephone Assessment & Management
Provider Type
Non-physician Health Care Professional
What is the Service?
Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent or guardian
Not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment
HCPCS / CPT Code
Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10; 11-20; or 21-30 minutes of medical discussion
98966 (5-10 minutes)
98967 (11-20 minutes)
98968 (>21 minutes)
Requirements
Requires an audiovisual connection or telephone
Established patient, parent or guardian
Cannot be related to a medical visit within the previous 7 days or lead to a visit within 24 hours or soonest available appointment
5-10; 11-20; or 21-30 minutes of medical discussion
For additional information and current COVID-19 policy details contact Aetna provider service representative.
Special Instructions
Additional information refer to Aetna’s telehealth policy
Telephone Assessment & Management
Provider Type
Physician or other qualified health care professional who may report E&M services
What is the Service?
Telephone evaluation and management service by a physician or other qualified health care professional 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 nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment
HCPCS / CPT Code
Telephone evaluation and management service by a physician or other qualified health care professional 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 nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10; 11-20; or 20-30 minutes of medical discussion.
99441 (5-10 minutes)
99442 (11 – 20 minutes)
99443 (20 – 30 minutes)
Requirements
Requires telephone
Established patient, parent or guardian
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
Physician may provide care from any location
For additional information and current COVID-19 policy details contact Aetna provider service representative.
Special Instructions
Aetna is extending all member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services through 9/30/2020 (Commercial and Medicare Advantage Plans).
Self-insured plans offer this waiver at their own discretion.
Medicare Advantage cost sharing will be waived for covered real-time virtual visits offered by in-network providers (live videoconferencing or telephone-only telemedicine services). Medicare Advantage members are encouraged to use telemedicine for any reason, not just COVID-19 diagnosis.
Virtual Check-in
Provider Type
MD/ANP
What Is The Service?
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.
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.
HCPCS / CPT Code
HCPCS code 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.
HCPCS 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.
Requirements
Requires an audiovisual connection or telephone
Cannot be related to a medical visit within the previous 7 days or lead to a visit within 24 hours
Coinsurance and deductible apply
For additional information and current COVID-19 policy details contact Aetna provider service representative.
Special Instructions
Aetna is extending all member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services through 9/30/2020 (Commercial and Medicare Advantage Plans.
Self-insured plans offer this waiver at their own discretion.
Medicare Advantage cost sharing will be waived for covered real-time virtual visits offered by in-network providers (live videoconferencing or telephone-only telemedicine services). Medicare Advantage members are encouraged to use telemedicine for any reason, not just COVID-19 diagnosis.
Online Digital E&M – e-Visit
Provider Type
MD/ANP
What is the Service?
A communication between a patient and their provider through an online patient portal
HCPCS / CPT Code
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10; 11-20; or 21 or more minutes.
99421 (5-10 minutes)
99422 (11-20 minutes)
99423 (>21 minutes)
Requirements
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10; 11-20; or 21 or more minutes.
– For established patients
– Requires audiovisual connection
*Communication with Patient via portal – patient must initiate
For additional information and current COVID-19 policy details contact Aetna provider service representative.
Special Instructions
Additional information refer to Aetna’s telehealth policy
Behavioral Health and Opioid Treatment
Provider Type
LCSW
What is the Service?
Specific details for these services can be found at https://www.aetna.com/health-care-professionals/provider-education-manuals/covid-faq/billing-and-coding.html
HCPCS / CPT Code
Requirements
Special Instructions
Additional information refer to Aetna’s telehealth policy
Aetna Medicare Advantage
Updated May 25, 2021
COVID-19: Telemedicine FAQs – Updated April 14, 2021
Telemedicine Policy
Provider Type
MD/ANP
What is the Service?
A visit with a provider that uses telecommunication systems between a provider and a patient
HCPCS / CPT Code
99201-99205
99211-99215
Requirements
For additional information and current COVID-19 policy details contact Aetna provider service representative.
Special Instructions
e-Visit
Provider Type
MD/ANP
What is the Service?
A communication between a patient and their provider through an online patient portal
HCPCS / CPT Code
G2061 (5-10 minutes)
G2062 (11-20 minutes)
G2063 (>21 minutes)
Requirements
For established patients
Communication with patient via portal – patient must initiate
For additional information and current COVID-19 policy details contact Aetna provider service representative.
Special Instructions
E-Visit
Additional information refer to Aetna’s telehealth policy
Cigna
Updated May 25, 2021
Commercial – Updated April 26, 2021: Medicare Telehealth Frequently Asked Questions (FAQs)
April 29, 2021: New Virtual Care Reimbursement Policy
January 1, 2021 – Note that the interim COVID-19 virtual care guidelines were in place through December 31, 2020. Refer to the New Virtual Care Reimbursement Policy above.
CIGNA Medicare Advantage
Updated April 26, 2021: COVID-19 Medicare Advantage Billing & Authorization Guidelines
Virtual Check-in (Telephone Consult)
Provider Type
In-Network Qualified Licensed Healthcare Provider
What is the Service?
Quick telephonic consultation related to COVID-19 screening and/or other necessary consults and will offer appropriate reimbursement to providers for this amount of time
HCPCS / CPT Code
HCPCS G2012
Phone calls for COVID-19 or other necessary consults (e.g.: 5-10 minute virtual visit with or without video with the licensed health care provider)
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
Requirements
Established patient
No co-pay
With or without video
For additional information and details regarding the Virtual Care Policy contact your Cigna provider representative.
Special Instructions
Virtual or face-to-face visit for screening for suspected or likely COVID-19 exposure
Provider Type
In-Network Qualified Licensed Healthcare Provider (Physicians, Mid-Level Practitioners)
What is the Service?
Real-time, synchronous virtual visit
Related to COVID-19
HCPCS / CPT Code
Usual face-to-face E/M code – 99202 – 99215
– Modifier CR on CMS 1500 claims or Condition code DR on UB04 claims
– Append with GQ modifier for virtual care
Requirements
For additional information and details regarding the Virtual Care Policy contact your Cigna provider representative.
Special Instructions
Use Diagnosis:
– Possible Exposure Z03.818
– Exposure Z20.828
– Z30.822
Virtual or face-to-face visit for treatment of a confirmed COVID-19 case
Provider Type
In-Network Qualified Licensed Healthcare Provider (Physicians, Mid-Level Practitioners)
What is the Service?
Real-time, synchronous virtual visit
Confirmed COVID-19 Case
HCPCS / CPT Code
Usual face-to-face E/M code
– Append with GQ modifier for virtual care*
*Note: contradictory guidance in “Cigna Coronavirus (COVID-19) Interim Billing Guidance for Providers” states on page 4 item e. “No virtual care modifier should be billed”.
Requirements
For additional information and details regarding the Virtual Care Policy contact your Cigna provider representative.
Special Instructions
Telehealth (Non-COVID-19 virtual visit)
Provider Type
In-Network Qualified Licensed Healthcare Provider (Physicians, Mid-Level Practitioners)
What is the Service?
Real time, synchronous
HCPCS / CPT Code
Usual face-to-face E/M code – 99202–99215
– Append with GQ modifier for virtual care
– POS normally billed**
**Billing a POS 02 or GT/95 modifier for virtual services may result in reduced payment or denied claims due to current system limitations. While we understand CMS guidance is to bill for a POS 02 for virtual care services, billing a typical place of service (POS 11) will ensure providers receive the same reimbursement as they typically get for a face-to-face visit.
Requirements
Services must be interactive and use both audio and video internet-based technologies (synchronous) to be reimbursed at the face-to-face rate
Additional information can be found through the Virtual Care Reimbursement Policy
For additional information and details regarding the Virtual Care Policy contact your Cigna provider representative.
Special Instructions
Telephone Only
Provider Type
Qualified Providers
What Is The Service?
Telephone evaluation and management service provided by a physician or other qualified healthcare professional who may report E/M 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.
HCPCS / CPT Code
99441 – 99443
Requirements
Established patient
For additional information and details regarding the Virtual Care Policy contact your Cigna provider representative.
Special Instructions
UnitedHealthcare
Revised May 25, 2021
UnitedHealthcare Expands Access to Care, Support and Resources to Help People and Families Address COVID-19 – March 18, 2020
COVID-19 Telehealth Services – Updated May 13, 2021
¥ Update January 29, 2021: Summary of COVID-19 Dates by Program LINK
§ Update: December 21, 2020: COVID-19 UnitedHealthcare Telehealth Services: Care Provider Coding Guidance LINK
Electronic Visit
Revised June 5, 2020
Provider Type
Physician or other Qualified Healthcare Provider
What is the Service?
These services are for established patients, not related to a medical visit within the previous 7 days and not resulting in a medical visit within the next 24 hours (or soonest appointment available) using online patient portal
HCPCS / CPT Code
Established patients may have non-face-to-face, patient-initiated communications with their doctors, without going to the doctor’s office, by using online patient portals.
Physician, ANP, PA:
99421 (5-10 minutes)
99422 (11-20 minutes)
99423 (>21 minutes)
Place of Service: 11, 20 22, 23
Requirements
Use of online patient portal
Established patient
Patient must generate initial inquiry
Communication can occur over a seven-day period
Patient must verbally consent to receive virtual check-in services
Use appropriate Place of Service (11, 20, 22, 23)
No modifiers are required for commercial, Medicare Advantage or (UHC) Medicaid
Review plan coverage or contact your United Healthcare customer service representative for updated plan details.
Review the “Summary of COVID-19 Dates by Program” document for a quick reference guide to the beginning and ending dates of temporary program, process or procedure changes implemented by payer because of COVID-19. ¥
Medicaid: State regulations will apply ¥
Review the Telehealth provider coding guidance for additional information and updates §
Special Instructions
Virtual Check-in: Audio Only
Revised Nov. 2, 2020
Provider Type
Physician or Qualified Health Care Professional
What is the Service?
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 – using audio-only technology
HCPCS / CPT Code
G2012 or G2252
These virtual check-ins are for patients with an established (or existing) relationship with a physician or certain practitioners, where the communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours (or soonest appointment available).
5-10 minutes of medical discussion
Requirements
Use appropriate Place of Service (11, 20, 22, 23)
Established patient
5-10 minutes of medical discussion
Furnished through communication technology modalities such as telephone
The patient must verbally consent to receive virtual check-in services
Review plan coverage or contact your United Healthcare customer service representative for updated plan details.
Review the “Summary of COVID-19 Dates by Program” document for a quick reference guide to the beginning and ending dates of temporary program, process or procedure changes implemented by payer because of COVID-19. ¥
Medicaid: State regulations will apply ¥
Review the Telehealth provider coding guidance for additional information and updates §
Special Instructions
Medicare Telehealth Visits
Revised June 5, 2020
Provider Type
In-network physician, nurse practitioner or physician assistant
What is the Service?
New or Established patient visit using HIPAA compliant or non-HIPAA compliant audio-video technology for COVID-19 or non-COVID-19 care.
HCPCS / CPT Code
New Patient:
- E/M Code: 99202 – 99205
Established Patient:
- E/M Code: 99211 – 99215
- Appropriate POS:
- Medicare: 11, 20, 22, 23
- Commercial and Medicaid: 02
- Modifier:
- Medicare: 95
- Commercial and Medicaid: Not required
Requirements
These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits
Telehealth services provided via the use of HIPAA-compliant or non-HIPAA-compliant audio-video or audio-only technology, such as FaceTime or Skype*
For new or established patients
Review plan coverage or contact your United Healthcare customer service representative for updated plan details.
Review the “Summary of COVID-19 Dates by Program” document for a quick reference guide to the beginning and ending dates of temporary program, process or procedure changes implemented by payer because of COVID-19. ¥
Review the Telehealth provider coding guidance for additional information and updates §
Medicaid: State regulations will apply ¥
Special Instructions
Telehealth services will be reimbursed in accordance with the member’s benefit plan. – Updated December 21, 2020
Virtual Check-in
Provider Type
MD/ANP/PA
What is the Service?
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
HCPCS / CPT Code
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
Requirements
For established patients
No modifiers required for commercial, Medicare Advantage or UHC Medicaid
Use appropriate Place of Service code (11, 20, 22, 23)
Cannot be related to a medical visit within the previous 7 days or lead to a visit within 24 hours
Furnished through captured video or image
The patient must verbally consent to receive virtual check-in services
Review plan coverage or contact your United Healthcare customer service representative for updated plan details.
Review the “Summary of COVID-19 Dates by Program” document for a quick reference guide to the beginning and ending dates of temporary program, process or procedure changes implemented by payer because of COVID-19. ¥
Medicaid: State regulations will apply ¥
Review the Telehealth provider coding guidance for additional information and updates §
Special Instructions
Humana/TRICARE
Revised May 25, 2021
Humana
Telehealth – Expanding Access to Care
Humana Telehealth – Expanding access to care virtually – March 23, 2020
COVID-19 Benefits – Updated January 1, 2021
2021 Medicare Advantage: COVID-19 Telehealth and Other Virtual Services Policy – Updated January 8, 2021
Tricare
Coronavirus Disease (COVID-19) and TRICARE’s telemedicine benefit – Updated April 29, 2020
TRICARE temporarily revises telemedicine benefit – Updated June 17, 2020
Telemedicine
Provider Type
MD/ANP
What is the Service?
A visit with a provider who uses telecommunication systems between a provider and a patient
HCPCS / CPT Code
99201-99205
99211-99215
- POS that would have been reported if furnished in person
- Modifier 95
Requirements
For additional information refer to: 2021 Medicare Advantage: COVID-19 Telehealth and Other Virtual Services Policy Updated: January 8, 2021
Special Instructions
E-Visit
Provider Type
Physician
What Is The Service?
Online digital evaluation and management non-face-to-face communication through an online patient portal.
HCPCS / CPT Code
Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 5-10 minutes; 11-20 minutes; 21 or more minutes.
– 99421 – 99423
Bill with proper code utilizing POS as the medical office and modifier according to CMS Guidance, state-specific rules and Humana policy.
Requirements
Services for established patient.
Service initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation.
Communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours.
The patient must verbally consent to receive services
For additional information refer to: 2021 Medicare Advantage: COVID-19 Telehealth and Other Virtual Services Policy Updated: January 8, 2021
Special Instructions
Telephone Visits
Provider Type
Qualified health care professional
What Is The Service?
Non-face-to-face telephone services: Telephone evaluation and management service by a physician or other qualified health care professional
HCPCS / CPT Code
Telephone evaluation and management service by a physician or other qualified health care professional 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 nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes; 11-20 minutes; 21-30 minutes of medical discussion
– 99441-99443
Bill with proper code utilizing POS as the medical office and modifier according to CMS Guidance, state-specific rules and Humana policy.
Requirements
Services for established patient
Service provided via telephone
Communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours.
See payer details for cost-sharing information.
For additional information refer to: 2021 Medicare Advantage: COVID-19 Telehealth and Other Virtual Services Policy Updated: January 8, 2021
Special Instructions
Services for established patient
Service provided via telephone
Communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours
See payer details for cost sharing information
Virtual Check-In
Provider Type
Physician or other qualified health care professional
What Is The Service?
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional.
HCPCS / CPT Code
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional.
Virtual Check-in use HCPCS: G2012
Requirements
Services for new or established patient
Patient must initiate
Communication is not related to a medical visit within the previous 7 days or lead to a medical visit within the next 24 hours
Patient must verbally consent to receive virtual check-in
See payer details for cost-sharing information
For additional information refer to: 2021 Medicare Advantage: COVID-19 Telehealth and Other Virtual Services Policy Updated: January 8, 2021