Billing coding telehealth telemedicine services

​Understanding Telemedicine:
Telemedicine is the delivery of medical healthcare services using HIPAA-compliant and secure electronic communications, information technology, or other electronic or technological means to bridge the gap between a health care provider who is located at a distant site and a patient who is located at an originating site, either with or without the assistance of an intervening health care provider for the purpose of diagnosis, consultation, and/or treatment of a patient. We need to understand though that Telemedicine does not include the use:

• Electronic Mail or e-mail
• Instant Messaging
• Phone Texting
• Facsimile Transmission
• Audio-only Telephone Conversation

What a "Distant site" means - it is a site which the health care provider, working within their scope of practice and a valid license or certification, is located while providing health care services by means of HIPAA-compliant telemedicine technology.

What an "Originating site" means - it is a site at which a patient is located at the time that health care services are provided to the patient by means of telemedicine.

Synchronous means live (real-time live), two-way interaction between a person and a provider using audio-visual telecommunications technology.

Asynchronous also known as “store and forward” or “non-interactive telecommunication” means the acquisition and transmission of images, diagnostics, data, and medical information either to, or from, and originating site or to, or from, the healthcare provider at a distant site which allows for the patient to be evaluated without being physically present.

What are the covered services in Telemedicine? Well it depends on your insurance payers.

But you can find Medicare's guidelines here, CLICK HERE.

Other Payers?, you can scroll down as I have added several payers.

Common Modifiers used for Telehealth Services

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Modifier 95
Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. Please refer to Appendix P within the American Medical Association’s Current Procedural Terminology (CPT®) code manual to review the CPT codes for which a "95" modifier can be used to indicate that the service was provided via a real-time, interactive audio and video telecommunications system.

​Modifier GT
Via interactive audio and video telecommunications systems

Modifier GQ
Services provided via asynchronous


** always check with your payers if the above Modifiers are acceptable based on their policy.

 Place of Service code use  02

*** check with your payers if POS 02 is applicable for telemedicine services based on their policy

Commercial and Private Payers Policy

PAYERS LIST IN ANY ORDER

CMS Medicare Guideline

Medicare Telehealth Covered CPT and HCPCS CODES. Click here.

Blue Cross Blue Shield of New Jersey - Telemedicine Services
The following lists of codes is provided as an informational tool only, to help identify some of the applicable CPT® codes/code ranges and HCPCS codes that may be utilized in reporting telemedicine services. The inclusion of a specific code does not indicate eligibility for coverage in all situations.

CPT Codes
90785, 90863, 96116, 90791-90792, 90832-90838, 90839-90840, 90845-90847, 90951-90961, 90963-90966, 90967-90970, 96150-96154, 96160-96161, 97802-97804, 99201-99205, 99211-99215, 99231-99233, 99241-99245, 99251-99255, 99307-99310, 99354-99357, 99406-99407, 99408-99409, 99495-99496, 99497-99498

 HCPCS Codes
G0108-G0109, G0270, G0296, G0396-G0397, G0406, G0407, G0408, G0420-G0421, G0425-G0427, G0438-G0439, G0459, G0473, G0506, G0508-G0509, G0513-G0514, S0199

The following services are not eligible for reimbursement under this policy:

• Non-direct patient services (e.g. coordination of care rendered before or after patient interaction) will not be considered for reimbursement.
• Claims submitted with modifier GQ, which signifies services provided via asynchronous telecommunications system, as these services do not include direct in-person patient contact.
• Any service that is not eligible for separate reimbursement when rendered to the patient in-person.
• Presentation/origination site facility fee (HCPCS code Q3014).
• CPT codes 99441-99444.
• Health care providers providing telemedicine services shall be subject to the same standard of care or practice standards as are applicable to in-person settings.
• Documentation in the medical record must be maintained and must support the services rendered.
• Utilization review by Horizon BCBSNJ may be performed.

*** READ THE ENTIRE BCBS NJ POLICY HERE.