Question: What is considered Telehealth services? Can we bill for these services now that carriers are loosening their requirements as a response to COVID-19?
Answer: This entire area of telehealth services is an evolving topic amongst insurance carriers and information may change several times before final guidance emerges. In the meantime, we can offer the following general guidance:
For COVID-19 illness-related virtual visits, national guidance has emerged that governmental and commercial carriers will recognize and reimburse for telehealth services without copay or cost-sharing to the patient.
For all other virtual visits, several commercial carriers have published guidance in this area. However, this may not be reflective of all commercial payors.
General Organization of Telehealth Services
Three main types of virtual visits or services have emerged under current guidance. These are as follows:
- Telehealth visits
- Virtual check-ins
These are described as a provider-patient visit that uses audio or video telecommunication between the parties. These are applicable for new or established patients.
For commercial coverages, the appropriate CPT will be based on the content and length of the visit with the palette of existing office-visit codes now available for billing of these services (99201 – 99215). Current guidance generally suggests that a telephone call is sufficient; however, best practice recommends using a professional grade combined audio and video product or service as the telecommunication protocol.
For Medicare coverages, these are described as visits conducted between a provider and a patient using two-way telecommunication systems with audio AND video capabilities. Office visit codes 99201 – 99215 should be used.
These are described as a brief 5 or 10-minute conversation initiated by the patient where a physician addresses a concern and decides whether an office visit or other service is needed for established patients only. Generally, HCPCS codes G2012 or G2010 would be used for both Medicare and commercial coverages.
These are described as a communication between a patient and their provider through an on-line patient portal for established patients only. Generally, HCPCS codes G2012 or G2010 would be used for both Medicare and commercial coverages.
Tips on Best Practice by Providers
For Medicare coverages, the “type of virtual communication” required to bill these services is audio & video combined. This means using a professional Skype-like product that is HIPAA compliant.
For best-practice, we recommend all virtual visits be conducted and recorded using a professional-grade audio and video combined product or service.