Telemedicine billing can be a headache because a virtual visit isn't the same as an in-person visit, it has to be coded differently. This can lead to errors on claims and give insurance companies grounds to deny payment. In order to get compensation for telemedicine visits, billing departments should keep the following tips in mind when processing bills for payers.
Research the Payer
While most insurances are required by law to cover telemedicine visits at a comparable rate to in-person visits, they may all have different requirements for how you log the visit. In order to make sure a doctor's office is adhering to their guidelines, it's important to do some research before submitting a claim. The best way to do this is to give them a call and ask the following questions:
- What telemedicine services are covered?
- What types of healthcare providers can bill for telemedicine?
- Is there a limit on the number of covered telemedicine visits?
- Are there any specific conditions required for telemedicine visits?
Choose the Right CPT Code
Once the billing department has determined the insurance company's guidelines, they can then begin coding the visit in question. Generally, the CPT code that the office would use for an in-person visit can be used for a telemedicine visit, but there are some exceptions.
One good example to consider is CPT codes 99201 to 99215, which are the codes commonly used for an office or other outpatient visit. These can be used for telemedicine visits as well, but they'll require a bit more work on the part of the doctor. They'll need to meet two of the three following requirements in order to receive full reimbursement:
- Be a low complexity medical decision making visit
- Offer an expanded, problem-focused exam
- Have an expanded, problem-focused medical history
- Spend 15 minutes face-to-face with the patient
While coverage varies for different insurance companies, Medicare has provided a helpful list of the specific CPT codes they cover in a telehealth setting. Offices may have to end up using code 99444, which is a telemedicine-specific code that specifies the visit was an "online evaluative and management service."
Satisfy the Originating Site Requirement
In order for Medicare to cover these types of visits, there is also one more qualifying factor - location. Medicare requires patients to receive visits at specific originating sites, including:
- A physician or practitioner's office
- Critical Access Hospitals
- Rural health clinics
Luckily, most private insurance companies do not have a specific location requirement, meaning that the visit can take place anywhere and still be covered.
Related Article: Telemedicine in Georgia: How to introduce in a medical practice
Use the GT or GQ Modifier
Of course, simply using the appropriate CPT code is not enough. Since Medicare and insurance companies wish to track the number of telemedicine visits, they often require offices to append a GT or GQ modifier to the end of the CPT code. Which one to use will depend on what kind of service was provided.
- A GQ modifier is used for asynchronous telecommunication system visits
- A GT modifier is used for interactive audio and telecommunications system visits
By adding this code, it will let the payer know that the visit did not take place in a physical setting. Going back to the example CT code 99201, a telemedicine visit with this code would be listed as 99201 GT.
While coding telemedicine visits can be tricky, it's no more complicated than the normal billing process once you understand the rules. For more guidance on how to properly use CPT codes and GT modifiers, M-Scribe Technologies, LLC can help. We have years of experience providing medical claims billing and coding services. Just call us at 888-727-4234 or email firstname.lastname@example.org to get started.