CMS is currently reimbursing for several technology-based services beyond traditional audiovisual telehealth in addition to telephone calls. Because of cost-sharing requirements associated with these services, these services must be patient initiated which is indicative of patient consent for the service. The cost-sharing waivers associated with traditional audiovisual telehealth services do not apply for the technology-based services described in this section. Further, the codes described in this section do not require a telehealth modifier.
Virtual Check-In and Remote Evaluation Codes
CMS approved coverage of these two new services effective for the 2019 Physician Fee Schedule. AAPM&R provided detailed education on these services in an article in the Physiatrist in May 2019. Coverage guidelines have been changed somewhat due to COVID-19 as described below.
- Under new (COVID related) guidelines from CMS, these codes can be used for both new and established patients.
- Code G2012 applies to services provided using any real-time audio (telephone), or "2-way audio interactions that are enhanced with video or other kinds of data transmission." (Can use non-HIPAA compliant technology during the COVID-19 public health emergency.)
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Code
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Descriptor
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Facility Fee
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Non Facility Fee
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G2010
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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.
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$9.38
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$12.27
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G2012
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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 withinthe next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
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$13.35
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$14.80
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Online Digital Evaluation and Management Service
- The service must include evaluation, assessment and management of the patient’s condition.The service may include review of patient records, ordering of tests and communication with the patient through digitally supported communication (email, phone call, etc). This communication does not need to be real-time.
- These codes are to be reported only once per 7-day period (using cumulative time spent).
- Use only once per 7-day period.
- Service time must be more than 5 minutes and clinical staff time is not included in the cumulative time total.
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Code
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Descriptor
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Facility Fee
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Non Facility Fee
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99421
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Patient-initiated digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
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$13.35
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$15.52
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99422
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Patient-initiated digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
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$27.43
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$31.04
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99423
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Patient-initiated digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
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$43.67
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$50.16
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- Under new (COVID related) guidelines from CMS, these codes can be used for both new and established patients.
- Involves "asynchronous transmission of healthcare information" from the patient. If the images are not sufficient to perform the evaluation, the service is not billable.
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Code
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Descriptor
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Facility Fee
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Non Facility Fee
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99453
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Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
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$18.77
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$18.77
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99454
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Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
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$62.44
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$62.44
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99457
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Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff, physician or other qualified health professional time in a calendar month requiring interactive communication with the patient/caregiver during the month
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$32.84
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$51.61
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