Guide to Telehealth: Billing for Office Visits

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CMS historically has covered a range of services when provided via telehealth.  A complete list of services reimbursable when performed by telehealth can be found on the Medicare website.  This list of services has been expanded under new authority.  Additional details can be found in the Expansion of Covered Services section of this guide. 

During the COVID-19 public health emergency, many physiatrists are performing standard office visits via telehealth.  These services should be billed using standard E/M codes.  For example, a level 3 office visit provided to an established patient via telehealth should be billed using code 99213. 

Additionally, CMS has announced that during the COVID-19 public health emergency, levels for office and outpatient E/M telehealth services can be selected based on Medical Decision Making (MDM) or time (total time associated with the E/M on the day of the encounter). Further, specific to these telehealth services, CMS has removed any requirements regarding documentation of history and/or physical exam in the medical record for office and outpatient E/M telehealth visits.

Modifiers and Place of Service

Telehealth services provided via real-time interactive audiovisual technology should be billed with the place of service (POS) code that would have been used had the service been provided in person, such as POS 11 (private practice) instead of 02 (telehealth).  CMS has also directed providers to append modifier -95 to all telehealth services billed using POS 11.