30 Most Common Billing Codes for Telehealth & Remote Monitoring Services

The Covid-19 pandemic has forced local and federal governments to embrace telehealth as means of combating the crisis. From the Congress passing the spending bill on March 6th which included $500 million for the expansion of telehealth, to the Centers for Medicare and Medicaid Services (CMS) lifting on March 30th the restrictions on telehealth services paid through Medicare along with individual states waiving licensure requirements, more and more physicians are able to utilize a variety of platforms to see and care for their patients remotely. In fact, covid-19 is dramatically changing the US telehealth market which is expected to grow 80% YOY in 2020 and “at a CAGR of over 29% during the period 2019–2025” according to a report published on Reportlinker.

However, here comes the first hurdle: how do we get paid NOW???

Simply removing the policy barriers does not provide hospital administrators and physicians with an easy way to bill and get reimbursed for telemedicine services that have been provided since most never had to bill for those types of services before.

To help alleviate the difficulty in accessing this vital piece of information, we have compiled a list of 30 Most Common Medicare Telehealth Series and Billing Codes:

Telehealth

Category	Codes	Associated Time	Medicare Rate	Code Description
LucidAct Health
Online Digital E/M Services	99421 99422 99423	5-10 mins 11-20 mins 21+ mins	$15.52 $31.04 $50.16	Online digital E/M service for an established patient for up to 7 days, cumulative time during the 7 days
Prolonged Services w/o Direct Patient Contact	99358 99359	First Hour Each Addtl. 30 mins	$113.68 $55.58	Prolonged E/M service before/or after direct patient care
Prolonged E/M service before/or after direct patient care	99201 99202 99203 99204 99205	10 mins 20 mins 30 mins 45 mins 60 mins	$46.56 $77.23 $109.35 $169.09 $211.12	-Problem focused hx and exam; straightforward medical decision making - Expanded problem focused hx and exam; straight forward med decision -Detailed hx and exam, low medical decision-making -Comprehensive hx and exam, moderate medical decision-making - Comprehensive hx and exam, high medical decision-making
Office/Outpatient visit for E/M of established patient	99211 99212 99213 99214 99215	5 mins 10 mins 15 mins 25 mins 40 mins	$23.46 $46.19 $76.15 $110.43 $148.33	Same as above, except for established patient
Inter-professional Telephone/Internet/EHR Consultation	99446 99447 99448 99449	5-10 mins 11-20 mins 21-30 mins 31+ mins	$18.41 $37.17 $55.58 $73.98	Interprofessional telephone/Internet/EHR assessment and management services provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other QHP
	99451	5+ mins	$37.53	Interprofessional telephone/Internet/EHR assessment and management services provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other QHP
	99452	30 mins	$37.53	Interprofessional telephone/Internet/EHR referral services provided by a treating/requesting physician or other QHP
	G2010	N/A	$12.27	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
	G2012	5-10 mins	$14.80	Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management 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 within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

Remote Monitoring

Category	Codes	Associated Time	Medicare Rate	Code Description
LucidAct Health
Digitally stored data services/Remote physiologic monitoring	99453	N/A	$18.77	Remote monitoring of physiologic parameter(s) (e.g. weight, blood-pressure, pulse oximetry, respiratory flow rate), initial setup and patient education on use of equipment
	99454	N/A	$62.44	Remote monitoring of physiologic parameter(s) (e.g. weight, blood-pressure, pulse oximetry, respiratory flow rate), initial device(s) supply with daily recording(s) or programmed alert(s) transmission. Each 30 days
	99091	Min. 30 mins	$59.19	Collection and interpretation of physiologic data(e.eg. ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 mins of time, each 30 days
	99473	N/A	$11.19	Self-measured blood pressure using a device validated for clinical accuracy, patient education/training and device calibration
	99474	N/A	$15.16	… separate self-measurements of two readings one minute apart, tice daily over a 30-days period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified healthcare professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient
Remote physiologic monitoring treatment management services	99457 99458	First 20 mins Each Addtl. 20 mins	$51.61 42.22	Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with a patient/caregiver during the month

With the LucidAct Platform providers are capable of administrating, documenting, and billing for these codes as well as other telehealth services. Connect with our experts today to discover more about how LucidAct can help you prepare for the future.