Telemedicine Billing

As web based technologies continues to evolve, it’s becoming clearer that telemedicine is the future of patient care. As this trend continues to emerge, it’s important to stay up to date on all of the rules and regulations if you want to be successful. By learning how to integrate telemedicine into your medical practice early on, you’ll have a head start when it finally does become standard across the board.

How Telemedicine Works
To start a telemedicine program at your office, you’ll probably want to partner with one of the major telemedicine providers in the country, such as Doctor on Demand, HealthTap, American Well, MDLive, or Teladoc. These providers offer the platform through which your doctors perform visits. Even better, for times when you aren’t available, patients will be able to see a doctor employed by the telemedicine service.

In order to make the service effective, you may want to set aside time for online appointments only. However, because much of telemedicine is on-demand, it’s also possible to create a virtual waiting room, where patients can sit in a queue until the doctor has time to see them.

Chose the right CPT Codes and GT Modifiers
We help providers to get paid for their telemedicine patient care services. First, we carefully review payer contracts with regards to state specific telemedicine rules and regulations. Once we know providers are in the network, we begin coding the patient visits. Generally, the CPT code that the office would use for an in-person visit can be used for a telemedicine visit, but there are some exceptions.

One good example to consider is CPT codes 99201 to 99215, which are the codes commonly used for an office or other outpatient visit. These can be used for telemedicine visits as well, but they’ll require a bit more work on the part of the doctor. They’ll need to meet two of the three following requirements in order to receive full reimbursement:

• Be a low complexity medical decision making visit
• Offer an expanded, problem-focused exam
• Have an expanded, problem-focused medical history
• Spend 15 minutes face-to-face with the patient

While coverage varies for different insurance companies, Medicare has provided a helpful list of the specific CPT codes they cover in a telehealth setting.  Offices may end up using code 99444, which is a telemedicine-specific code that specifies the visit was an “online evaluative and management service.”

Of course, simply using the appropriate CPT code is not enough. Since Medicare and insurance companies wish to track the number of telemedicine visits, they often require offices to append a GT or GQ modifier to the end of the CPT code. Which one to use will depend on what kind of service was provided.

• GQ modifier is used for asynchronous telecommunication system visits
• GT modifier is used for interactive audio and telecommunications system visits

By adding this code, it will let the payer know that the visit did not take place in a physical setting. Going back to the example CT code 99201, a telemedicine visit with this code would be listed as 99201 GT.

If you need further assistance you can call us any time.