Telemedicine and Telehealth solutions that were emerging technologies are now at the forefront of healthcare delivery, playing a significant role in offering secure digital healthcare services to patients across the globe. In fact, the Centers for Medicare & Medicaid Services (CMS) has rolled out new policies, guidelines and regulations to support telemedicine solutions with a whopping 76% of U.S hospitals providing teleconsulting services. An American Medical Association (AMA) report indicates that telemedicine solutions are amongst the fastest evolving innovations with a growth rate of a staggering 53%.

Various external factors have been contributing to these changes. Firstly, there has been a paradigm shift in healthcare systems including the centralization of data and infrastructure that has increased the challenges of identifying in-network providers. Furthermore, the COVID-19 outbreak has made telemedicine solutions necessary for healthcare organizations to provide secure care services.

Common CPT Codes

Healthcare organizations across the U.S use a standard set of codes identified by the key stakeholders. These CPT codes are listed in tandem with the health concern to facilitate the billing process. Once the teleconsultation has been completed, the billing team can use the corresponding code to bill the payer. Below are the common set of CPT codes used for the billing.

Post COVID-19 Priorities to Address Revenue Loss and Margin Impact

Service	HCPCS/CPT Code
Telehealth consultations, emergency department or initial inpatient	G0425-G0427
Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs	G0406-G0408
Office or other outpatient visits	99201-99215
Subsequent hospital care services, with the limitation of 1 telehealth visit every three days	99231-233
Subsequent nursing facility care services, with the limitation of one telehealth visit every 30 days	99307-99310
Individual and group kidney disease education services	G0420-G0421
Individual and group diabetes self-management training services, with a minimum of one hour of in-person instruction furnished in the initial year training period to ensure effective injection training	G0108-G0109
Individual and group health and behavior assessment and intervention	96150-96154
Individual psychotherapy	90831-90838
Telehealth pharmacologic management	G0459
Psychiatric diagnostic interview examination	90791-90792
End-stage renal disease (ESRD)-related services included in the monthly capitation payment	90951,90952, 90954,90955, 90957,90958, 90960, 90961
End-stage renal disease (ESRD)-related services for home dialysis per full month, for patients younger than two years of age to include monitoring for adequacy of nutrition, assessment of growth and development, and counseling of parents	90963
End-stage renal disease (ESRD)-related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for adequacy of nutrition, assessment of growth and development, and counseling of parents	90964
End-stage renal disease (ESRD)-related services for home dialysis per full month, for patients 12-19 years of age to include monitoring for adequacy of nutrition, assessment of growth and development, and counseling of parents	90965
End-stage renal disease (ESRD)-related services for home dialysis per full month, for patients 20 years of age or older	90966
End-stage renal disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age	90967
End-stage renal disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients 2-11 years of age	90968
End-stage renal disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients 12-19 years of age	90969
End-stage renal disease (ESRD)-related services for dialysis less than a full month of service, per day; for patients 20 years of age or older	90970
Individual and group medical nutrition therapy	G0270, 97802- 97804
Neurobehavioral status examination	96116
Smoking cessation services	G0436, G0437, 99406, 99407
Alcohol and/or substance (other than tobacco) abuse structures assessment and intervention services	G0396,G0397
Annual alcohol misuse screening, 15 minutes	G0442
Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes	G0443
Annual depression screening, 15 minutes	G0444
High-intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes	G0445
Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes	G0446
Face-to-face behavioral counseling for obesity, 15 minutes	G0447
Transitional care management services with moderate medical decision complexity (face-to-face visit within 14 days of discharge)	99495
Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge)	99496
Advance care planning, 30 minutes	99497
Advance care planning, additional 30 minutes	99498
Psychoanalysis	90845
Family psychotherapy (without the patient present)	90846
Family psychotherapy (conjoint psychotherapy) (with patient present)	90847
Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour	99354
Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes	99355
Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; first hour (list separately in addition to code for inpatient evaluation and management service)	99356
Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; each additional 30 minutes (list separately in addition to code for inpatient evaluation and management service)	99357
Annual wellness visit, includes a personalized prevention plan of service (PPPS) first visit	G0438
Source: Centers for Medicare & Medicaid Services (CMS)

Outsourcing Medical Billing Services / Telemedicine Billing

If you are amongst the countless healthcare organizations that have adopted telemedicine solutions to mitigate the impact of the COVID-19 pandemic, you are most likely experiencing billing uncertainties more than ever. So instead of managing an in-house telemedicine billing team by training staff, adapting to the constantly changing regulations, consider partnering with an experienced healthcare revenue cycle management company.

A well-orchestrated team of revenue cycle management can ensure that they focus on the intricacies and the nuances of medical billing, while you stay focused on higher priority tasks like patient care. However, it is essential that you find an ideal medical billing partner who can handle the critical aspects of your Hospital or Practice. You will need to identify a revenue cycle management company abreast with the latest updates and regulatory changes, software techniques, profound experience and knowledge of the healthcare industry. You will need a medical billing services company that will be as concerned about accelerating your revenue cycle curve as you are.

SolvEdge

As a leading Medical billing company, SolvEdge has been offering customized billing solutions to our clients across the globe. By partnering with us, you will gain the expertise of a welltrained billing team without incurring the overhead costs. Immaterial of whether you are a small Practice or a large healthcare setup, our certified and experienced coders and billers can handle the complex billing structure and are updated with the latest regulations.

What’s more, our Billing team has shown drastic results in the shortest span of time.

Combined with actionable insights provided by our revenue cycle experts, working with SolvEdge has the potential to increase revenues by as much as 30%. To get our No Cost Gap Analysis to recoup your missed out revenues and to accelerate your revenue cycle performance, talk to our team