Editor’s note: The information contained in this article is current as of May 2021 and is based on CMS regulations. Please note that these regulations change often, and while we will do our best to stay current, we advise you to also reference the CMS’s Telehealth Services page for the most accurate information. Additionally, many commercial payers have different requirements.
For physical therapists, occupational therapists, and speech-language pathologists, telehealth and other virtual services can be an excellent adjunct to your practice. But knowing what remote services are covered by Medicare is critical to building a successful program. So, we’ve compiled this handy Medicare cheat sheet for outpatient rehab therapists, breaking down telehealth and communication technology-based service (CTBS) procedure codes.
Curious to learn more about Medicare Telehealth compliance? Check out this webinar with compliance expert Nancy Beckley.
Medicare Telehealth Terminology and Billing Guidelines
First, let’s define the three types of virtual services Medicare covers. “Virtual services” is the umbrella term CMS uses for remote visits. You may also hear the term “communication technology-based services” or CTBS, which constitutes brief services conducted over different types of technology.
Each type of service will have different billing requirements that must be met to be covered by Medicare. We recommend reviewing the full Medicare Telemedicine fact sheet prior to submitting claims.
- E-Visits: When a provider communicates and conducts synchronous or asynchronous assessments on a patient, typically through an online portal.
- When billing: These services require an established relationship between provider and patient.
- Medicare Telehealth Visits: When the therapist offers a virtual service where the provider cares for a patient over a live, synchronous video stream.
- When billing: These services are covered for the duration of the COVID-19 public health emergency (PHE) if the provider already has an established relationship with the patient. These visits are billed using standard CPT codes that are accepted by Medicare for telehealth services.
- Virtual Check-ins: A virtual service where the provider conducts synchronous or asynchronous assessments or communicates with the patient via “a broader range of communication methods.” Telephone and short telehealth check-ins with patients fall under this category.
- When billing: These services require an established relationship between provider and patient. Some codes require a timeframe of contact between the patient and qualified healthcare professional not originating from a related assessment or service provided in the previous 7 days, within the next 24 hrs., or the soonest available appointment (marked with * in our charts).
Telehealth Procedure Codes for Physical Therapists
To access a printable billing code cheat sheet for PT’s click here
| Code | Short Descriptor | Status During PHE | Audio Only Allowed? |
|---|---|---|---|
| 97110 | Therapeutic exercises | Available up through year in which PHE ends | – |
| 97112 | Neuromuscular reeducation | Temporary addition for PHE | – |
| 97116 | Gait training therapy | Temporary addition for PHE | – |
| 97150 | Group therapeutic procedures | Temporary addition for PHE, added 4/30/2020 | – |
| 97161 | PT eval, low complex, 20 mins | Available up through year in which PHE ends | – |
| 97162 | PT eval, moderate complex, 30 mins | Available up through year in which PHE ends | – |
| 97163 | PT eval, high complex, 45 mins | Available up through year in which PHE ends | – |
| 97164 | PT re-eval, established plan of care | Available up through year in which PHE ends | – |
| 97530 | Therapeutic activities | Temporary addition for PHE, added 4/30/2020 | – |
| 97535 | Self-care management training | Available up through year in which PHE ends | Yes |
| 97542 | Wheelchair management training | Temporary addition for PHE, added 4/30/2020 | – |
| 97750 | Physical performance test | Available up through year in which PHE ends | – |
| 97755 | Assistive technology assessment | Available up through year in which PHE ends | – |
| 97760 | Orthotic management and training, 1st encounter | Available up through year in which PHE ends | – |
| 97761 | Prosthetic training, 1st encounter | Available up through year in which PHE ends | – |
Telehealth Procedure Codes for Occupational Therapists
To access a printable billing code cheat sheet for OT’s click here
| Code | Short Descriptor | Status During PHE | Audio-Only Allowed? |
|---|---|---|---|
| 97110 | Therapeutic exercises | Available up through year in which PHE ends | – |
| 97112 | Neuromuscular reeducation | Temporary addition for PHE | – |
| 97116 | Gait training therapy | Temporary addition for PHE | – |
| 97150 | Group therapeutic procedures | Temporary addition for PHE, added 4/30/2020 | – |
| 97165 | OT eval, low complex, 30 mins | Available up through year in which PHE ends | – |
| 97166 | OT eval, moderate complex, 45 mins | Available up through year in which PHE ends | – |
| 97167 | OT eval, high complex, 60 mins | Available up through year in which PHE ends | – |
| 97168 | OT re-eval, established plan of care | Available up through year in which PHE ends | – |
| 97530 | Therapeutic activities | Temporary addition for PHE, added 4/30/2020 | – |
| 97535 | Self-care management training | Available up through year in which PHE ends | Yes |
| 97542 | Wheelchair management training | Temporary addition for PHE, added 4/30/2020 | – |
| 97750 | Physical performance test | Available up through year in which PHE ends | – |
| 97755 | Assistive technology assessment | Available up through year in which PHE ends | – |
| 97760 | Orthotic management and training, 1st encounter | Available up through year in which PHE ends | – |
| 97761 | Prosthetic training, 1st encounter | Available up through year in which PHE ends | – |
Telehealth Procedure Codes for Speech-Language Pathologists
To access a printable billing code cheat sheet for SLP’s click here
| Code | Short Descriptor | Status During PHE | Audio-Only Allowed? |
|---|---|---|---|
| 92507 | Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual | Added 3/30/2020 | Yes |
| 92508 | Treatment of speech, language, voice, communication, and/or auditory processing disorder; group | Added 3/3/2020 | Yes |
| 92521 | Evaluation of speech fluency (eg. stuttering, cluttering) | Added 3/3/2020 | Yes |
| 92522 | Evaluation of speech sound production (eg. articulation, phonological process, apraxia, dysarthria) | Added 3/3/2020 | Yes |
| 92523 | Evaluation of speech sound production (eg. articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg. receptive and expressive language) | Added 3/3/2020 | Yes |
| 92524 | Behavioral and qualitative analysis of voice and resonance | Added 3/3/2020 | Yes |
| 92526 | Oral function therapy | Temporary addition for PHE, added 3/30/2021 | - |
| 92607 | Exam for speech device Rx, 1 hr. | Temporary addition for PHE, added 3/30/2021 | - |
| 92608 | Exam for speech device Rx, additional time | Temporary addition for PHE, added 3/30/2021 | - |
| 92609 | Use of speech device service | Temporary addition for PHE, added 3/30/2021 | - |
| 92610 | Evaluate swallowing function | Temporary addition for PHE, added 3/30/2021 | - |
| 96105 | Assessment of aphasia | Temporary addition for PHE, added 3/30/2021 | - |
| 96125 | Cognitive test by HC pro | Temporary addition for PHE, added 3/30/2021 | - |
| 97129 | Therapeutic cognitive function intervention (ivntj), 1st 15 mins | Temporary addition for PHE, added 3/30/2021 | - |
| 97130 | Therapeutic ivntj, each additional 15 mins | Temporary addition for PHE, added 3/30/2021 | - |
Other Allowable Communication Technology-Based Services for Physical or Occupational Therapy
CMS has issued the following disposition for these CTBS CPT codes:
“These HCPCS/CPT codes are designated for use only for the duration of the COVID-19 public health emergency (PHE) and are applicable for claims beginning March 1, 2020. The following HCPCS/CPT codes are for services furnished virtually that represent therapy services collectively termed ‘communication technology-based services’ (CTBS) – including E-visits (G2061 – G2063) and telephone assessment and management services (Codes 98966 – 98968). These codes are ‘always therapy’ services when furnished by a therapist and in these situations require the use of a therapy modifier − GP, GO, or GN − in order to indicate the service is furnished under a physical therapy, occupational therapy, or speech-language pathology plan of care, respectively.
“[These codes] are not therapy services when both of the following conditions are met:
- It is not appropriate to bill the service under a therapy plan of care, and
- They are billed by practitioners who are not therapists, such as physicians, clinical nurse specialists, nurse practitioners, physician assistants, psychologists, social workers, etc., who may also be able to report them.
“These codes may be used when the related service is furnished by a therapist who established/ establishes the therapy plan or who assumes responsibility for the plan, including the therapist in private practice who independently bills for [their] services and the therapist whose services are billed by the institutional provider of therapy services. Although these services are furnished virtually, they must continue to meet documentation and reasonable and necessary criteria for therapy services as outlined in therapy manuals.”
| Code | Short Descriptor |
|---|---|
| 98966 | A telephone assessment and case management service of about 5-10 mins conducted by a qualified non-physician healthcare professional. * |
| 98967 | A telephone assessment and case management service of about 11-20 mins of medical discussion, provided by a qualified nonphysician health professional. * |
| 98968 | A telephone assessment and case management service of about 12-30 mins provided by a qualified nonphysician health professional. * |
| 98970 | An online digital assessment and management service conducted by a qualified nonphysician healthcare professional for an established patient, taking about 5-10 mins for up to 7 days or cumulative time during those 7 days. |
| 98971 | An online digital assessment and management service conducted by a qualified nonphysician healthcare professional for an established patient, taking about 11-20 mins for up to 7 days or cumulative time during those 7 days. |
| 98972 | An online digital assessment and management service conducted by a qualified nonphysician healthcare professional for an established patient, taking 21 or more mins for up to 7 days or cumulative time during those 7 days. |
| G2250 | Remote evaluation of recorded video and/or images submitted by an established patient, including interpretation with follow-up with the patient within 24 business hrs. * |
| G2251 | Brief CTBS, such as a virtual check-in, by a physician or other qualified healthcare professional who cannot report evaluation and management services, provided to an established patient for about 5-10 mins of medical discussion. * |
*CMS: Visit must not originate from a related assessment or service (including emergency medical, or e/m) provided within the previous 7 days, nor leading to an assessment or procedure within the next 24 hrs. or soonest available appointment.
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