![]() There are no POS or modifier requirements for virtual check-ins or e-visits.Virtual check-ins and e-visits must technically be initiated by a patient however, physicians and other providers may need to educate beneficiaries on the availability of the service prior to patient initiation.Patient consent is required and may be obtained either before or at the time of service. ![]() The AAFP recommends reaching out to your provider relations representatives or Medicare Administrative Contractors (MACs) to verify policies. ![]() Similarly, Medicaid policies are established at the state-level. Self-funded plans can develop their own policies and may opt out of some cost-sharing waivers. when performed during the same service period at CPT codes 99495-99496.during the same month with CPT codes 9949, and.when CPT codes 99339-9934-99380 are used for the same call,.if CPT codes 99421-99423 have been reported by the same physician in the previous seven days for the same problem,.Telephone E/M services should not be reported when the time spent on the telephone is captured in other services reported, such as: 99443: telephone E/M service, 21-30 minutes of medical discussion.99442: telephone E/M service 11-20 minutes of medical discussion.99441: telephone E/M service 5-10 minutes of medical discussion.The following codes may be used by physicians or other qualified health professionals who may report E/M services: Telephone E/M services are provided to a patient, parent, or guardian and do not originate from a related E/M service within the previous seven days and do not lead to an E/M service or procedure within the next 24 hours or soonest available appointment. Other services that may be provided via audio-only are available on the Medicare Telehealth List. Check with your provider relations representatives for each payer’s telehealth policy and covered telehealth services.ĬMS will cover telephone evaluation and management (E/M) services (CPT codes 99441-99443) through the end of calendar year 2023. ![]() Private payers vary on covered telehealth services. CPT codes billed with modifier -93 that are not in Appendix P will not be considered for payment. Eligible services must be reported using either POS 02 or 10 and include the -93 modifier. UHC states they will consider payment for eligible audio-only services listed in Appendix P of the CPT book. Medicare allows audio-only telehealth services for office visit E/M services (CPT codes 99202-99215) for the treatment of mental health conditions. Eligible services may be found on the Medicare Telehealth Services list. Audio-only encounters are allowed for certain services. Medicare requires audio-video for most office visit evaluation and management (E/M) services (CPT codes 99202-99215) telehealth services. Use POS that would have been used if the service had been provided in person (e.g., POS 11 – Office)Ĭommercial:-GQ, -GT, or -95 (all three accepted) Medicare Advantage: Use the POS that would have been used if the service had been provided in person (e.g., POS 11 – Office) Check with your local provider relations representative Medicare Advantage: Elevance policy not publicly available. Medicare Advantage: Use POS that would have been used if the service had been provided in person (e.g., POS 11 – Office)
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