Practice Support Update Blog

2021 Medicare Telehealth Coding Updates

Jan 11, 2021 9:00:00 AM / by Practice Support Team

The Centers for Medicare & Medicaid Services (CMS) issued a final rule on December 1st, 2020 that includes policy updates for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2021. 

Medicare Telehealth and Other Services Involving Communications Technology 

For CY 2021, CMS finalized the addition of the following list of services to the Medicare telehealth list (see abbreviated list below, not complete) on a Category 1 basis: 

  • telehealth_03-web-main_0Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99334-99335) 
  • Home Visits, Established Patient (CPT codes 99347-99348) 
  • Cognitive Assessment and Care Planning Services (CPT code 99483) 
  • Visit Complexity Inherent to Certain Office/Outpatient Evaluation and Management (E/M) (HCPCS code G2211) 
  • Prolonged Services (HCPCS code G2212) 

Service Type 

HCPCS 

Long Descriptor 

Domiciliary, Rest Home, or Custodial Care services, Established patients 

99334 

Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent with the patient and/or family or caregiver. 

99335 

Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver. 

Home Visits, Established Patient 

99347 

Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family. 

99348 

Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family. 

Cognitive Assessment and Care Planning Services 

99483 

Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements: Cognition-focused evaluation including a pertinent history and examination; Medical decision making of moderate or high complexity; Functional assessment (eg, basic and instrumental activities of daily living), including decision-making capacity; Use of standardized instruments for staging of dementia (eg, functional assessment staging test [FAST], clinical dementia rating [CDR]); Medication reconciliation and review for high-risk medications; Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s); Evaluation of safety (eg, home), including motor vehicle operation; Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks; Development, updating or revision, or review of an Advance Care Plan; Creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed (eg, rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support. Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver. 

Visit Complexity Inherent to Certain Office/Outpatient Evaluation and Management (E/M) 

G2211 

Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (Add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established). 

Prolonged Services 

G2212 

Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (List separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services) (Do not report G2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416) (Do not report G2212 for any time unit less than 15 minutes). 

 

Additionally, CMS finalized the creation of a third temporary category of criteria for adding services to the list of Medicare telehealth services. Category 3 services added to the Medicare telehealth list during the public health emergency (PHE) for the COVID-19 pandemic (COVID-19 PHE) will remain on the list through the calendar year in which the PHE ends. 

CMS finalized the addition of the following services to the Medicare telehealth list (see abbreviated list below, not complete) on a Category 3 basis:  

  • Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99336-99337) 
  • Home Visits, Established Patient (CPT codes 99349-99350) 

 

Service Type 

HCPCS 

Long Descriptor 

Domiciliary, Rest Home, or Custodial Care services, Established patients 

99336 

Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 or these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity.  Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.  Usually, the presenting problem(s) are of moderate to high severity.  Typically, 40 minutes are spent with the patient and/or family or caregiver. 

99337 

Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 or these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity.  Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.  Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention.  Typically, 60 minutes are spent with the patient and/or family or caregiver. 

Home Visits, Established Patient 

99349 

Home visit for the evaluation and management of an established patient, which requires at least 2 or these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity.  Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.  Usually, the presenting problem(s) are of moderate to high severity.  Typically, 40 minutes are spent with the patient and/or family or caregiver. 

99350 

Home visit for the evaluation and management of an established patient, which requires at least 2 or these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity.  Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.  Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention.  Typically, 60 minutes are spent with the patient and/or family or caregiver. 

 

Providing services using audio/visual technology when patient and practitioner are in the same location 

Questions as to whether services should be reported as telehealth when the individual physician or practitioner furnishing the service is in the same location as the beneficiary; for example, if the physician or practitioner furnishing the service is in the same institutional setting but is utilizing telecommunications technology to furnish the service due to exposure risks. Therefore, CMS reiterates in this final rule that telehealth rules do not apply when the beneficiary and the practitioner are in the same location even if audio/video technology assists in furnishing a service. 

 

Note: The information provided herein is for educational purposes only and is not intended to be construed as coding or billing advice. Please refer to the source documents below for more detailed guidance.  

 

References 

https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1 

https://www.ama-assn.org/system/files/2020-05/telehealth-services-covered-by-Medicare-and-included-in-CPT-code-set.pdf 

https://www.cms.gov/files/document/mm12071.pdf 

 

 

Tags: coding, telehealth, medicare

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