Telehealth Billing Guidelines for Orthopedics

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Telehealth Billing Guidelines for Orthopedics
During the COVID-19 public health emergency,
reimbursements for telehealth continue to evolve.
The federal government, state Medicaid programs,
and private insurers have expanded coverage for
virtual health care services. More Medicare
Fee-for-Service (FFS) services are billable as
telehealth during the COVID-19 public health
emergency. In this blog, we shared telehealth
billing guidelines for medical billing specialty
orthopedics. This article will answer basic
telehealth billing questions like How should I
bill telehealth? How to bill for Medicare
telehealth visits? Which procedure codes and
modifiers should I use? What are the restrictions
I should watch out for?  Video Visit
Billing The CPT codes for virtual video visit
billing are 99201-99215. CPT 99201-99205 are for
new patients while 99211-99215 are for
established patients. We recommend limiting
televisits to established patients. Please note
that American Medical Association CPT rules may
differ from CMS guidelines. It is important to
know which guidelines your commercial carrier is
following. The documentation for these
encounters is the same as in-person requirements
(except the exam). For
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Telehealth Billing Guidelines for Orthopedics
example, code 99213 requires either Expanded
problem-focused history and low complexity
medical decision-making, or 15 minutes spent
face-to-face with the patient if coding based on
time.  Look for additional information to
come about wearables/remote monitoring/sensors,
detailed reimbursement, legal pearls, pitfalls
when scaling, and more. The place of service
would be 02 i.e., the location where health
services and health-related services are provided
or received, through a telecommunication
system. Telehealth modifier may vary based on
the service provider i.e., GT modifier used to
indicate a service rendered via synchronous
telemedicine GQ modifier used to report
services delivered via asynchronous
telecommunications system modifier 95 used when
billing to some private payers. 
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Telehealth Billing Guidelines for Orthopedics
Telephone Visit Billing Telephone services
without face-to-face discussion are not
frequently reimbursed. These codes are not
billable if the call results in the patient
coming in for a face-to-face service within the
next 24 hours or the next available urgent visit.
Medicare wont cover telephone billing codes
(99441 5-10 minutes, 99442 11-20 minutes,
and 99443 21-30 minutes). Telephone calls are
also not billable if they refer to an E/M service
performed within the last seven days. Coverage of
telephone calls is not consistent so it is
important to check the coverage and payment for
various payers.   Medicare Telehealth Visits A
telehealth visit is defined as a visit with a
provider that uses telecommunication systems
between a provider and a patient. The HCPCS/CPT
codes for common telehealth services include CPT
99201-99215 (Office or other outpatient
visits) CPT G0425-G0427 (Telehealth
consultations, emergency department or initial
patient) CPT G0406-G0408 (Follow-up inpatient
telehealth consultations furnished to
beneficiaries in hospitals or skilled nursing
facilities).
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Telehealth Billing Guidelines for Orthopedics
These visits are designated for new or
established patients. HHS will not conduct audits
to ensure that such a prior relationship existed
for claims submitted during this public health
emergency. Please note that this billing
information is taken from CMS Medicare
Telemedicine Healthcare Provider Fact Sheet which
describes the types of virtual services for
Medicare Beneficiaries. Refer to CMS for
a complete list of telehealth services payable
under the Medicare Physician Fee
Schedule. Virtual Check-in Virtual check-in is
defined as 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. A remote
evaluation of recorded video and/or images
submitted by an established patient. The
HCPCS/CPT codes for this type of visit
include HCPCS code G2012 and HCPCS code G2010.
These virtual check-in codes are used with
established patients. E-Visits This type of
visit is defined as communication between a
patient and their provider through an online
patient portal. The HCPCS/CPT codes for this type
of visit include CPT 99421, 99422, 99423, G2061,
G2062, G2063. These e-visit codes are used with
established patients.
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Telehealth Billing Guidelines for Orthopedics
If you still have confusion over telehealth
billing and coding, you can contact us for more
information. Medical Billers and Coders (MBC) is
a leading provider of orthopedics medical billing
and coding services. Our expertise over
orthopedics medical billing ensures quick and
accurate insurance reimbursements. To know more
about our orthopedics revenue cycle services,
contact us at info_at_medicalbillersandcoders.com/888
-357-3226. FAQs 1 How should I bill for
telehealth services? You should use CPT codes
99201-99215 for video visits, with specific codes
for new (99201-99205) and established patients
(99211-99215). 2 How do I bill for Medicare
telehealth visits? Medicare telehealth visits
can be billed using codes like CPT 99201-99215
and HCPCS G0425-G0427 for consultations,
regardless of patient status. 3 What modifiers
should I use for telehealth billing?
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Telehealth Billing Guidelines for Orthopedics
Use modifier GT for synchronous services, GQ for
asynchronous services, and modifier 95 for some
private payers when billing telehealth. 4 What
are the restrictions for telephone visit
billing? Telephone services are often not
reimbursed and cannot be billed if they result in
a face-to-face visit within 24 hours or refer to
an E/M service within the last seven days. 5
What are virtual check-ins and e-visits? Virtual
check-ins (HCPCS G2012, G2010) are brief
communications to assess service needs, while
e-visits (CPT 99421-99423, G2061-G2063) involve
patient-provider communication through an online
portal.