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PRINT-FRIENDLY VERSIONTELEHEALTH SERVICESTarget Audience: Medicare Fee-For-Service ProvidersThe Hyperlink Table, at the end of this document, provides the complete URL for each hyperlink.CPT codes, descriptions and other data only are copyright 2018 American Medical Association. All Rights Reserved.Applicable FARS/HHSAR apply. CPT is a registered trademark of the American Medical Association. Applicable FARS/HHSAR Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or relatedcomponents are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMAdoes not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for datacontained or not contained herein.Page 1 of 13ICN MLN901705 March 2020
Telehealth ServicesMLN BookletTABLE OF CONTENTSOriginating Sites. 4Distant Site Practitioners. 6Telehealth Services. 7Telehealth Services Billing and Payment. 11Telehealth Originating Sites Billing and Payment. 11Resources.12Helpful Websites. 13Regional Office Rural Health Coordinators. 13Page 2 of 13ICN MLN901705 March 2020
Telehealth ServicesMLN BookletCMS Alert!Medicare Beneficiaries Expanded Telehealth Benefits During COVID-19 OutbreakUnder the Coronavirus Preparedness and Response Supplemental Appropriations Actand Section 1135 waiver authority, the Centers for Medicare & Medicaid Services (CMS)broadened access to Medicare telehealth services, so beneficiaries can get a wider range ofservices from their doctors and other clinicians without traveling to a health care facility. OnMarch 6, 2020, Medicare began temporarily paying clinicians to furnish beneficiary telehealthservices residing across the entire country.Before this announcement, Medicare could only pay clinicians for telehealth services, suchas routine visits in certain circumstances. For example, the beneficiary getting the servicesmust live in a rural area and travel to a local medical facility to get telehealth services froma doctor in a remote location. In addition, the beneficiary generally could not get telehealthservices in their home.Under this Section 1135 waiver expansion, a range of providers, such as doctors, nursepractitioners, clinical psychologists, and licensed clinical social workers, can offer aspecific set of telehealth services. The specific set of services beneficiaries can get includeevaluation and management visits (common office visits), mental health counseling, andpreventive health screenings. Beneficiaries can get telehealth services in any health carefacility including a physician’s office, hospital, nursing home or rural health clinic, as wellas from their homes. This change broadens telehealth flexibility without regard to thebeneficiary’s diagnosis, because at this critical point it is important to ensure beneficiariesfollow CDC guidance including practicing social distancing to reduce the risk of COVID-19transmission. This change will help prevent vulnerable beneficiaries from unnecessarilyentering a health care facility when clinicians can meet their needs remotely.To read the Fact Sheet on this announcement visit: elemedicine-health-care-provider-fact-sheetTo read the Frequently Asked Questions on this announcement visit: alth-frequently-asked-questions-faqs-31720.pdfPage 3 of 13ICN MLN901705 March 2020
Telehealth ServicesMLN BookletLearn about these Medicare telehealth services topics: Originating sites Distant site practitioners Telehealth services Telehealth services billing and payment Telehealth originating sites billing and payment Resources Helpful websites and Regional Office Rural Health CoordinatorsMedicare pays for specific (Part B) physician or practitioner services furnished through atelecommunications system. Telehealth services substitute for an in-person encounter.ORIGINATING SITESAn originating site is the location where a Medicare beneficiary gets physician or practitioner medicalservices through a telecommunications system. The beneficiary must go to the originating site for theservices located in either: A county outside a Metropolitan Statistical Area (MSA) A rural Health Professional Shortage Area (HPSA) in a rural census tractThe Health Resources and Services Administration (HRSA) decides HPSAs, and the Census Bureaudecides MSAs. To see a potential Medicare telehealth originating site’s payment eligibility, go toHRSA’s Medicare Telehealth Payment Eligibility Analyzer.Providers qualify as originating sites, regardless of location, if they were participating in a Federaltelemedicine demonstration project approved by (or getting funding from) the U.S. Department ofHealth & Human Services as of December 31, 2000.Beginning July 1, 2019, the Substance Use-Disorder Prevention that Promotes OpioidRecovery and Treatment (SUPPORT) for Patients and Communities Act removes theoriginating site geographic conditions and adds an individual’s home as a permissibleoriginating telehealth services site for treatment of a substance use disorder or a co-occurringmental health disorder.Page 4 of 13ICN MLN901705 March 2020
Telehealth ServicesMLN BookletEach December 31 of the prior calendar year (CY), an originating site’s geographic eligibility is basedon the area’s status. This eligibility continues for a full CY. Authorized originating sites include: Physician and practitioner offices Hospitals Critical Access Hospitals (CAHs) Rural Health Clinics Federally Qualified Health Centers Hospital-based or CAH-based Renal Dialysis Centers (including satellites) Skilled Nursing Facilities (SNFs) Community Mental Health Centers (CMHCs) Renal Dialysis Facilities Homes of beneficiaries with End-Stage Renal Disease (ESRD) getting home dialysis Mobile Stroke UnitsNote: Medicare does not apply originating site geographic conditions to hospital-based andCAH-based renal dialysis centers, renal dialysis facilities, and beneficiary homes whenpractitioners furnish monthly home dialysis ESRD-related medical evaluations. IndependentRenal Dialysis Facilities are not eligible originating sites.Beginning January 1, 2019, the Bipartisan Budget Act of 2018 removed the originating sitegeographic conditions and added eligible originating sites to diagnose, evaluate, or treatsymptoms of an acute stroke. Go to MLN Matters article, New Modifier for Expanding the Useof Telehealth for Individuals with Stroke to learn how to use the new modifier for billing.Page 5 of 13ICN MLN901705 March 2020
Telehealth ServicesMLN BookletDISTANT SITE PRACTITIONERSDistant site practitioners who can furnish and get payment for covered telehealth services (subject toState law) are: Physicians Nurse practitioners (NPs) Physician assistants (PAs) Nurse-midwives Clinical nurse specialists (CNSs) Certified registered nurse anesthetists Clinical psychologists (CPs) and clinical social workers (CSWs)CPs and CSWs cannot bill Medicare for psychiatric diagnostic interview examinations withmedical services or medical evaluation and management services. They cannot bill or get paidfor Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838. Registered dietitians or nutrition professionalCPT only copyright 2018 American Medical Association. All rights reserved.Page 6 of 13ICN MLN901705 March 2020
Telehealth ServicesMLN BookletTELEHEALTH SERVICESYou must use an interactive audio and video telecommunications system that permits real-timecommunication between you at the distant site, and the beneficiary at the originating site.Transmitting medical information to a physician or practitioner who reviews it later is permitted only inAlaska or Hawaii Federal telemedicine demonstration programs.CY 2019 Medicare Telehealth ServicesServiceHCPCS/CPT CodeTelehealth consultations, emergency department or initial inpatientG0425–G0427Follow-up inpatient telehealth consultations furnished tobeneficiaries in hospitals or SNFsG0406–G0408Office or other outpatient visits99201–99215Subsequent hospital care services, with the limitation of 1telehealth visit every 3 days99231–99233Subsequent nursing facility care services, with the limitation of 1telehealth visit every 30 days99307–99310Individual and group kidney disease education servicesG0420–G0421Individual and group diabetes self-management training services,with a minimum of 1 hour of in-person instruction furnished in theinitial year training period to ensure effective injection trainingG0108–G0109Individual and group health and behavior assessment andintervention96150–96154Individual psychotherapy90832–90838Telehealth Pharmacologic ManagementG0459Psychiatric diagnostic interview examination90791–90792End-Stage Renal Disease (ESRD)-related services included in themonthly capitation payment90951, 90952, 90954, 90955,90957, 90958, 90960, 90961End-Stage Renal Disease (ESRD)-related services for homedialysis per full month, for patients younger than 2 years of ageto include monitoring for the adequacy of nutrition, assessment ofgrowth and development, and counseling of parents90963CPT only copyright 2018 American Medical Association. All rights reserved.Page 7 of 13ICN MLN901705 March 2020
Telehealth ServicesMLN BookletCY 2019 Medicare Telehealth Services (cont.)ServiceHCPCS/CPT CodeEnd-Stage Renal Disease (ESRD)-related services for home90964dialysis per full month, for patients 2–11 years of age to includemonitoring for the adequacy of nutrition, assessment of growth anddevelopment, and counseling of parentsEnd-Stage Renal Disease (ESRD)-related services for home90965dialysis per full month, for patients 12–19 years of age to includemonitoring for the adequacy of nutrition, assessment of growth anddevelopment, and counseling of parentsEnd-Stage Renal Disease (ESRD)-related services for homedialysis per full month, for patients 20 years of age and older90966End-Stage Renal Disease (ESRD)-related services for dialysisless than a full month of service, per day; for patients younger than2 years of age90967End-Stage Renal Disease (ESRD)-related services for dialysis less 90968than a full month of service, per day; for patients 2–11 years of ageEnd-Stage Renal Disease (ESRD)-related services for dialysis less 90969than a full month of service, per day; for patients 12–19 years ofageEnd-Stage Renal Disease (ESRD)-related services for dialysis less 90970than a full month of service, per day; for patients 20 years of ageand olderIndividual and group medical nutrition therapyG0270, 97802–97804Neurobehavioral status examination96116Smoking cessation servicesG0436, G0437, 99406, 99407Alcohol and/or substance (other than tobacco) abuse structuredassessment and intervention servicesG0396, G0397Annual alcohol misuse screening, 15 minutesG0442Brief face-to-face behavioral counseling for alcohol misuse,15 minutesG0443Annual depression screening, 15 minutesG0444CPT only copyright 2018 American Medical Association. All rights reserved.Page 8 of 13ICN MLN901705 March 2020
Telehealth ServicesMLN BookletCY 2019 Medicare Telehealth Services (cont.)ServiceHCPCS/CPT CodeHigh-intensity behavioral counseling to prevent sexuallytransmitted infection; face-to-face, individual, includes: education,skills training and guidance on how to change sexual behavior;performed semi-annually, 30 minutesG0445Annual, face-to-face intensive behavioral therapy forcardiovascular disease, individual, 15 minutesG0446Face-to-face behavioral counseling for obesity, 15 minutesG0447Transitional care management services with moderate medicaldecision complexity (face-to-face visit within 14 days of discharge)99495Transitional care management services with high medical decisioncomplexity (face-to-face visit within 7 days of discharge)99496Advance Care Planning, 30 minutes99497Advance Care Planning, additional 30 minutes99498Psychoanalysis90845Family psychotherapy (without the patient present)90846Family psychotherapy (conjoint psychotherapy) (with patientpresent)90847Prolonged service in the office or other outpatient setting requiringdirect patient contact beyond the usual service; first hour99354Prolonged service in the office or other outpatient setting requiringdirect patient contact beyond the usual service; each additional30 minutes99355Prolonged service in the inpatient or observation setting requiring99356unit/floor time beyond the usual service; first hour (list separately inaddition to code for inpatient evaluation and management service)Prolonged service in the inpatient or observation setting requiring99357unit/floor time beyond the usual service; each additional 30 minutes(list separately in addition to code for prolonged service)Annual Wellness Visit, includes a personalized prevention plan ofservice (PPPS) first visitCPT only copyright 2018 American Medical Association. All rights reserved.Page 9 of 13ICN MLN901705 March 2020G0438
Telehealth ServicesMLN BookletCY 2019 Medicare Telehealth Services (cont.)ServiceHCPCS/CPT CodeAnnual Wellness Visit, includes a personalized prevention plan ofservice (PPPS) subsequent visitG0439Telehealth Consultation, Critical Care, initial, physicians typicallyspend 60 minutes communicating with the patient and providersvia telehealthG0508Telehealth Consultation, Critical Care, subsequent, physicianstypically spend 50 minutes communicating with the patient andproviders via telehealthG0509Counseling visit to discuss need for lung cancer screening usinglow dose CT scan (LDCT) (service is for eligibility determinationand shared decision makingG0296Interactive Complexity Psychiatry Services and Procedures90785Health Risk Assessment96160, 96161Comprehensive assessment of and care planning for patientsrequiring chronic care managementG0506Psychotherapy for crisis90839, 90840Prolonged preventive servicesG0513, G0514A physician, NP, PA, or CNS must furnish at least one ESRD-related “hands on visit” (not telehealth)each month to examine the beneficiary’s vascular access site.CPT only copyright 2018 American Medical Association. All rights reserved.Page 10 of 13ICN MLN901705 March 2020
Telehealth ServicesMLN BookletTELEHEALTH SERVICES BILLING AND PAYMENTSubmit professional telehealth service claims using the appropriate CPT or HCPCS code.If you performed telehealth services “through an asynchronous telecommunications system”, add thetelehealth GQ modifier with the professional service CPT or HCPCS code (for example, 99201 GQ).You are certifying the asynchronous medical file was collected and transmitted to you at the distantsite from a Federal telemedicine demonstration project conducted in Alaska or Hawaii.Submit telehealth services claims, using Place of Service (POS) 02-Telehealth, to indicate youfurnished the billed service as a professional telehealth service from a distant site. As of January 1,2018, distant site practitioners billing telehealth services under the CAH Optional Payment Method IImust submit institutional claims using the GT modifier.Bill covered telehealth services to your Medicare Administrative Contractor (MAC). They pay youthe appropriate telehealth services amount under the Medicare Physician Fee Schedule (PFS). Ifyou are located in, and you reassigned your billing rights to, a CAH and elected the Optional PaymentMethod II for outpatients, the CAH bills the telehealth services to the MAC. The payment is 80 percentof the Medicare PFS facility amount for the distant site service.TELEHEALTH ORIGINATING SITES BILLING AND PAYMENTHCPCS Code Q3014 describes the Medicare telehealth originating sites facility fee. Bill your MAC forthe separately billable Part B originating site facility fee.Note: The originating site facility fee does not count toward the number of services used to determinepayment for partial hospitalization services when a CMHC serves as an originating site.CPT only copyright 2018 American Medical Association. All rights reserved.Page 11 of 13ICN MLN901705 March 2020
Telehealth ServicesMLN BookletRESOURCESTelehealth Services ResourcesFor More Information About Telehealth Downloads/clm104c12.pdfPhysician s/MLN-Publications-Items/CMS1246598.htmlHyperlink TableEmbedded HyperlinkComplete URLHealth Professional Shortage ServicePayment/HPSAPSAPhysicianBonusesMedicare Telehealth Payment icare/telehealthNew Modifier for Expanding the Use ofTelehealth for Individuals with 5th-congress/house-bill/6Substance Use-Disorder Preventionthat Promotes Opioid Recovery andTreatment (SUPPORT) for Patients andCommunities ActPage 12 of 13ICN MLN901705 March 2020
Telehealth ServicesMLN BookletHELPFUL WEBSITESAmerican Hospital Association RuralHealth tical Access Hospitals tical-Access-Hospitals-Center.htmlDisproportionate Share rally Qualified Health Centers lth Resources and Services Administrationhttps://www.hrsa.govHospital pital-Center.htmlMedicare Learning Network http://go.cms.gov/MLNGenInfoNational Association of Rural Health Clinicshttps://narhc.orgNational Rural Health Associationhttps://www.ruralhealthweb.orgRural Health Clinics al-Health-Clinics-Center.htmlRural Health Information Hubhttps://www.ruralhealthinfo.orgSwing Bed mation/TelehealthTelehealth Resource . Census Bureauhttps://www.census.govNational Association of CommunityHealth Centershttp://www.nachc.orgREGIONAL OFFICE RURAL HEALTH COORDINATORSTo find contact information for CMS Regional Office Rural Health Coordinators who provide technical,policy, and operational assistance on rural health issues, refer to care Learning Network Product DisclaimerThe Medicare Learning Network , MLN Connects , and MLN Matters are registered trademarks of the U.S. Departmentof Health & Human Services (HHS).Page 13
medical services or medical evaluation and management services. They cannot bill or get paid for Current Procedura
