In a world where telehealth is becoming a vital model of healthcare delivery, it is important to know how billing codes for telehealth are evolving to keep up with healthcare practice. Proper billing is important for getting paid on time as well as ensuring that you are in compliance with not only insurance payers like Medicare but with all insurers (including private ones like Aetna). With this rapid expansion, particularly following the COVID-19 pandemic, it is more important than ever to understand the nuances of telehealth billing codes, including the new Modifier 93. In this guide, we will clarify the different telehealth billing codes and look at the telehealth-specific codes for Medicare as well as Aetna’s telehealth billing policies, and the Modifier 93 use.
What Are Telehealth Billing Codes?
Telehealth billing codes is a code for telehealth services provided by the health care provider to the patient. These codes are used to set reimbursement rates for certain services, track telehealth services, and facilitate payment by insurance. Telehealth billing codes used include Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. Providers use the codes to submit claims to Medicare, Medicaid, private insurers, and other payers.
As new telehealth billing codes have been created, modified, and adjusted with telehealth’s rapid adoption, the updates will continue for the calendar year 2024. This complex billing environment leaves healthcare providers scrambling to keep up with the latest telehealth billing codes.
Key Telehealth Billing Codes 2024
In 2024, several telehealth billing codes 2024 expected to see updates and new modifiers have been introduced to improve accuracy in billing. Let’s review the most relevant codes for telehealth services:
- CPT Code 99421 – 99423: Remote assessment of patient-initiated, recorded health data. They are commonly used when a provider reviews patient data and renders medical advice through electronic means. An online consultation, for example through a secure patient portal.
- CPT Code 99201-99215: These are the usual codes for in-office visits, but they can be used during telehealth consultations as long as the consultation is conducted via a real-time interactive audio and video communication system. These codes remain valid for telehealth visits in 2024 as long as certain requirements are satisfied.
- CPT Code 99457 – 99458: These codes can be billed for remote monitoring with corresponding services. They encompass services that include reviewing and analyzing patient data remotely, usually in the context of chronic care management, like checking blood sugar levels or monitoring conditions of the heart.
- HCPCS Code G2010: A brief telehealth consult, such as a remote evaluation of recorded patient information, like an image, video or other data. This code is best used for follow-ups or assessments when the provider does not need to conduct a direct, real-time consultation.
- HCPCS Code G2012: Remote evaluation of patient information transmitted by the patient through a telecommunications technology system (telephonic or other electronic means).
The Role of Modifier 93 in Telehealth Billing
One of the biggest changes coming to the telehealth billing landscape in 2024 is the arrival of Modifier 93. It is used to show that a service was performed using real-time audio and visual technology (telehealth) but a telecommunications technology that is usually needed for telemedicine services is not used.
Telehealth services, especially ones using synchronous audio-video interactions, are reimbursed differently from standard face-to-face visits. Modifier 93 indicates that a telehealth service that has been rendered via technology is not normally considered telemedicine.
For instance, if the provider provided a telemedicine consultation through a video conference, but the service itself does not meet all telemedicine standards due to a low bandwidth of the device or if it is not HIPAA-compliant, Modifier 93 can be added to the CPT or HCPCS code to add that the service was still performed through telehealth.
This modifier lets cab rides be billed as just remote services for which providers were meeting the requirements, allowing for a smooth reimbursement process.
Medicare Billing Codes for Telehealth
Medicare has specific guidelines for telehealth services, and the Medicare billing codes for telehealth differ from those used by private insurers like Aetna. For 2024, Medicare is expanding its coverage to enhance access to healthcare, particularly for beneficiaries in rural and underserved areas.
These expanded Medicare billing codes for telehealth allow for a broader range of services, including virtual consultations, remote monitoring, and mental health services. Providers must use the correct Medicare billing codes for telehealth to ensure accurate reimbursement. Staying up-to-date with these codes is crucial for compliance and optimizing the claims process under Medicare’s evolving policies.
Medicare Telehealth Codes typically include:
CPT Codes 99421 — 99423: Online digital evaluation and management (E/M) services (for services when a provider reviews patient data submitted digitally, e.g., via patient portals, without real-time interaction, typically used for ongoing care or follow-ups)
CPT Codes 99201-99215: These are the CPT codes for telehealth consultations, and feature a variety of evaluation and management, ranging from new to established patient visits, and requiring simultaneous audio-visual communication between healthcare provider and patient.
G2025 (HCPCS Level II): Utilized for telehealth visits related to virtual check-ins for services in which a provider reviews patient symptoms remotely, generally through a telephone or video connection, and assesses whether additional care is warranted or if an in-person visit is required.
HCPCS Code G2012: Remote evaluation of patient generation health data, including images or recordings, submitted by a patient to be reviewed by the provider with the aim of addressing the condition and a plan for care.
Medicare also reimburses for telehealth services related to mental health, behavioral health, and physical therapy, making it an essential program for providers who treat these conditions remotely.
Aetna Telehealth Billing Codes
Other private insurers have also established their own policies and billing codes for telehealth services, but Aetna telehealth billing codes are known to set its own guidelines that clinicians must adhere to in order to receive payment for telehealth visits. This is a signal that Aetna will continue to the extent possible to cover the full range of telehealth services, including not only behavioral health, but also chronic disease management and other types of virtual healthcare. However, it is also vitally important for providers to be aware of Aetna’s specific billing needs for telehealth in 2024.
In many ways, Aetna operates similarly to Medicare, but there are more requirements for some services. For example, the Aetna telehealth billing codes might be:
CPT Code 99421-99: These codes are used for online digital evaluation and management of patients. They are relevant for services where providers asynchronously review patient-submitted data (such as health records, images, or text messages) using secure online platforms. These services are typically for low-acuity conditions or follow-up visits that do not require real-time interaction.
CPT Code 99201-99215: These codes are used to bill for office or outpatient consultations and for in-person or telehealth visits. They range from the 99201 for initial consultations to the 99211-99215 for established patients and include comprehensive evaluations, follow-up care, and preventive care. These codes cannot be used with any other types of care and telehealth visits using these codes need to meet documentation requirements and the type of platform used.
HCPCS Code G2012: This code was for virtual check-ins, or remote evaluations by phone or video. It is used when a provider evaluates patient symptoms remotely to decide, based on that assessment, whether in-person care or further consultation is needed.
G2012 is generally for short visit, G2012 allows for reimbursement for short, non-visit, face-to-face interactions.
Aetna, too, has specialty telehealth billing codes for mental health services, such as psychiatric consultations and therapy sessions. Providers need to be careful of the mental health telehealth guidelines because the need for services flows differently than physical health visits. Appropriate and comprehensive use of Aetna’s telehealth billing codes is critical to avoid claim denials and confirm correct reimbursement.
Common Telehealth Billing Challenges and How to Overcome Them
Billing for telehealth services can be complex, and providers often face several challenges in navigating the reimbursement process. Some of the most common issues include:
- Code Confusion: So many codes for so many telehealth services it can be difficult to know what code to use for what service. Healthcare providers need to stay current with coding changes and guidelines for Medicare, Aetna and other insurers.
- Eligibility Criteria: Medicare and Aetna and others set certain eligibility criteria for telehealth services. Every code does not always fit every case; some codes are registered only to some rural regions or specific diseases. Each provider must verify the eligibility of each patient prior to billing.
- Telemedicine Technology Requirements: In some cases, insurers may require telehealth services to be delivered via certain technologies or platforms. Not complying with these requirements could cause the claim to be rejected. Check the technical specifications, and always do so before any telehealth visit and even before you make an appointment.
- Modifier Use: It can be tricky to track the proper use of modifiers, including Modifier 93. Providers need to make sure they are properly applying the appropriate modifier to their claims, based on the type of telehealth service performed. Modifier 93 is used for telehealth services rendered through synchronous audio and video tools.
- Documentation: Telehealth claims must be properly documented and comprehensive. Be sure to document the telehealth service, being sure to include information such as the method of communication, type of service, and the patient’s condition as appropriate.
Best Practices for Telehealth Billing
Stay Informed
Telehealth billing codes and regulations are consistently evolving as telemedicine advances with new technologies being developed. Stakeholders in the healthcare industry must stay abreast of these updates so they remain compliant with the latest billing requirements. Providers can subscribe to the new coding resources and updates from reputable professional organizations, such as the American Academy of Physical Medicine and Rehabilitation (AAPM&R), to keep abreast of new guidelines and code changes.
Verify Insurance Coverage
With the exception of Medicare, reimbursement will vary widely between insurance plans, which is why it is so important to check patient insurance coverage before implementing telehealth services. The rules vary widely by insurer from which services qualify for telehealth coverage to what technology is acceptable for consultations to whether the patient’s specific plan has telehealth benefits. Verifying insurance coverage before the consultation can help avoid potential claim denials and misunderstandings on the road.
Use the Right Codes and Modifiers
Billing codes and modifiers for telehealth are both important to get reimbursed successfully. Any telehealth services must be separately billed using applicable CPT (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) codes, along with applicable modifiers (i.e, Modifier 93 [service delivered by real-time audio and video communication]).
Final Thoughts
To conclude, telehealth billing codes can be cumbersome to maneuver through, but healthcare providers must know how to navigate the latest changes in the 2024 updates, including Modifier 93, Medicare billing codes numbered 94 and 95, and Aetna’s telehealth billing codes. Providers can optimize reimbursement for telehealth services by clarifying the various billing codes associated with each service and submitting these codes with their claims. With telehealth continuing to expand and evolve, it’s critical to keep abreast of current guidelines if billing errors are to be avoided and access to care for patients is to be ensured.