Telehealth CPT Codes

In response to the recent expansion coverage for telemedicine from federal and commercial payers, we have added the following Telehealth CPT® codes to the billing sheet. 

Telehealth CPT Codes

All codes are listed under the Untimed Codes section of the patient’s note. 

Online Digital Evaluation and Management

98970, 98971, and 98972 refer to  online digital evaluation and management service provided by a qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days.

Codes should be chosen based on the duration of the telehealth appointment as follows:

• 98970: 5-10 minutes of medical discussion
• 98971: 11-20 minutes of medical discussion
• 98972: 21 or more minutes of medical discussion

Modifiers

Providers using these codes (98970, 98971, 98972) should bill Medicare using the  95 modifier. The use of this modifier indicates a real-time interaction between a physician—or other qualified healthcare professional—and a patient located at another site. Click here for more information on billing caveats.

Telephone Assessment and Management

98966, 98967, and 98968 refer to  telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment.

Codes should be chosen based on the duration of the telehealth appointment as follows:

• 98966: 5-10 minutes of medical discussion
• 98967: 11-20 minutes of medical discussion
• 98968: 21-30 minutes of medical discussion

These codes (98966, 98967, 98968) should be billed with the  Place of Service 11 or 12.

Virtual Care Codes

Starting January 1, 2021, codes G2250 and G2251 will replace codes G2010 and G2012. These untimed CPT codes will count as a visit toward the Medicare progress note requirement. 

G2250 and G2251 refer to communication technology-based services provided by PTs, OTs, and SLPs in private practice or facility-based clinics. These codes are permanent, meaning they are not restricted by the timeline of the COVID-19 public health emergency. 

• G2250: Remote assessment 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
• G2251: Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional, 5-10 minutes of medical discussion. 

PTs/OTs/SLPs: If you have billed for G2010 and G2012 for dates of service in 2021, replace G2010 with G2250 and G2012 with G2251.

DCs: Continue using G2010 and G2012. 

Regular Therapy Services and Management

For the duration of the COVID-19 emergency, Medicare will reimburse PTs, OTs, and SLPs for regular therapy services delivered via telehealth. To learn more about temporary CMS provisions, click here.

Covered codes include: 

• 97161 - 97168: Initial evaluations and re-evaluations
• 97110: Therapeutic exercise
• 97112: Neuromuscular re-education
• 97116: Gait training
• 97535: Self-care/home management training
• 97750: Physical performance test or measurement
• 97755: Assistive technology assessment
• 97760: Orthotics management and training
• 97761: Prosthetic training, upper and/or lower extremities, initial prosthetic encounter
• 92521 - 92524: Speech/language evaluations
• 92507: Speech/language treatment

Configure Code Visibility on Clinic Fee Schedule

You may customize which CPT codes show on the Company Fee Schedule. Please note that only company administrators can access this feature and changes will affect all users within the company.

1. Click on the clinic name in the upper right of WebPT, and select Company Fee Schedule. You cannot make these changes within the Clinic Fee Schedule.
   
2. To show or hide a particular CPT code, use the checkbox next to the code. In this example, the clinic does not want to see 98972 on their billing sheet.
      
3. Click the Save button to save the change for the clinic. 98972 will not appear on the billing sheet for all clinic users.
             
   

Managing Payer CPT Code Requirements

Many payers are taking different approaches to how therapists should be handling telemedicine, including which codes to bill, which place of service to select, and which modifiers to use. Because we do not have the option to segment out CPT Code availability by payer, we’ve put together the following suggestions to help you manage these varying requirements. 

• Create Payer Alerts for each payer you’ve confirmed will allow you to bill telehealth. Include the appropriate CPT code, modifier, place of service, etc. for the therapist.
• Edit the individual CPT code descriptions to tell therapists which payers allow which codes and other information such as place of service or modifiers. Follow the instructions from the Renaming Billing Codes section.