Part Two – Billing and Coding 101
As many are already aware, implementing Telehealth involves many moving parts – from selecting a product platform/vendor, to implementing it into the practice, to training the staff and providers. Let’s not forget about proper documentation, billing, and coding of telehealth services and navigating each payers’ guidelines, to maximize reimbursement.
CMS has published very specific guidance related to Telehealth billing and coding during the COVID-19 pandemic, such as removing the requirements regarding documentation of history and/or physical exam as part of providing additional flexibility to physicians. Providers are allowed to select the level of office/outpatient E/M based on medical decision making or time, and the current typical times associated with the office E/M are what should be met for the purposes of level selection. Additionally, it is imperative that patients verbally consent to Telehealth services, and it is documented in the medical record.
When billing telehealth services during the COVID-19 pandemic, it is important to understand and relay patient financial responsibility, as patient cost-share is waived by most payers for COVID-19 related visits, diagnosis codes, and testing. Co-pays, co-insurance, and deductibles may apply to normal, non-COVID-19 related telehealth visits.
| COVID-19 related codes | Codes not related to COVID-19 |
| U07.1 Positive COVID-19 test result or presumptive positive test result (Must be a confirmed case) with J12.89/J40/J22/J80/J98.9
Z20.828 Contact with & suspected exposure to other viral communicable diseases Z03.818 Encounter for observation for suspected exposure to other biological agents ruled out |
R05/R06.02/R50.9 or other signs/symptoms without a COVID-19 related ICD-10-CM code such as U07.1, Z20.828, or Z03.818 |
| G2023 or G2024
U0001 or U0002 87635 |
87880
87804 |
| Modifier –CS for Medicare |
See the link below for payer specific coding and billing guidelines:
Dean Dorton has experts available to assist your practice in Telehealth compliance, billing, coding, and documentation. Please do not hesitate to reach out to our experienced team with any questions you may have. We are committed to serving all of your healthcare needs.
Resource Links:
CMS – COVID-19 FAQs on FFS Billing/ List of Physician Fee Schedule Telehealth Services
COVID-19 FAQs on Medicare Fee-for-Service (FFS) BillingMedicare Telemedicine Healthcare Provider Fact SheetList of Physician Fee Schedule for Telehealth Services
MLN Matters – New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PHE)
MLN Matters Special Edition Article 20016
For more information on how the Coronavirus is impacting businesses across multiple industries, visit our COVID-19 resource page:
