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New Telemedicine CPT Codes Created

After a long wait, the Current Procedural Terminology (CPT) codes have finally been updated to include telemedicine. A “95” modifier can be added to CPT codes for real-time remote encounters with a video and audio component; the list includes outpatient evaluation and management (E/M) codes, consultation codes, and behavioral health codes, among others. Additionally, a new place of service (POS) code, telemedicine CPT code 02, is required for clinicians who bill for telemedicine services.

Each CPT code has strict documentation requirements. For instance, records of a direct counseling and/or coordination of care visit must include total time and percent spent in counseling and/or coordination of care.

In order to use the 95 modifier, the telemedicine visit must include a live video component. For in-home telemedicine visits, other peripherals may be used as well, including thermometers, oxygen saturation monitors, blood pressure monitors, glucose monitors, to name a few.

In addition, the 95 modifier requires qualifying services to be synchronous. The “store and forward” model, in which clinical data is stored and reviewed at a later time, may not be reimbursed under the new codes.

Under the 02 code, the Centers for Medicare & Medicaid Services (CMS) requires the Medicare beneficiary to be at an approved site for telemedicine. Other payers may be more lenient, allowing a patient to be at home or school for the telemedicine encounter.

At swyMed, we’re glad to see telemedicine gaining more acceptance. The new CMS codes indicate that telemedicine is becoming a frequently used tool in many disciplines.

To learn more about the new codes, click here.

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