The COVID-19 pandemic has accelerated the need to provide remote rehabilitation services utilizing teleconferencing technology.
Because of the COVID-19 crisis, CMS expanded their coverage of some virtual visits, or “e-visits” to physical therapists, occupational therapists, and speech-language pathologists, effective immediately. Special HCPCS codes have been published for e-visits and details about the requirements and reimbursement are included below. According to a recent fact sheet released by CMS, e-visits are “non-face-to-face patient-initiated communications through an online patient portal.”
Telehealth services require “interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home” and providers may “include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals.” Learn more about physical therapy telehealth, read our case study on how to implement telehealth in a PT practice.
MODE OF COMMUNICATION: Real-time, synchronous teleconference.
TYPE OF SERVICE: A visit with a new or established patient using telecommunication systems.
PT/OT CODES: 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, 97761
SLP CODES: 92507, 92508, 97521, 97522, 97523, 97524
Virtual Check-Ins are defined as a “brief communication service with practitioners via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image.”
MODE OF COMMUNICATION: Audio only via telephone or exchange of information through video or image.
TYPE OF SERVICE: Brief communication initiated by the patient to help determine whether they need to be seen for a full evaluation or treatment service.
DESCRIPTION: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment.
CMS allows clinicians to bill for remote review of prerecorded images and videos from the patient.
MODE OF COMMUNICATION: Asynchronous portal.
TYPE OF SERVICE: Interpretation of video/image.
MEDICARE CODE: G2010
DESCRIPTION: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
Telephone assessments can be used for lengthier discussions to address more complex or emergent issues identified by the patient or caregiver or when the patient does not have access to other modes of communication technology, such as a patient portal.
MODE OF COMMUNICATION: Audio only via telephone or telecommunication device.
TYPE OF SERVICE: Telephone assessment and management.
CODES: 98966, 98967, 98968
DESCRIPTION: Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment.
NOTE: Telephone assessments may also be used for self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes. CODE: 97535
Qualified non-physician online assessment (Medicare) or qualified non-physician online evaluation and management (non-Medicare), for an established patient.
TYPE OF SERVICE: Brief, online assessment.
MEDICARE CODES: G2061, G2062, G2063
EQUIVALENT NON-MEDICARE CODES: 98970, 98971, 98972
DESCRIPTION: E-visits describe brief, online assessments that are reported for cumulative time spent over the course of up to 7 days.
E-visits may only be used for established patients, meaning that the patient already has a plan of care and is known to your practice.
Providers may tell a patient that e-visit services are available, but the patient must request the service. There are three e-visit codes. Each code may be billed based on the cumulative time of the e-visits over a 7-day period:
The most practical way to utilize these new codes is to limit “e-visits” to once weekly.
Clinicient will be setting up specialized clinical content and charge capture rules to support these requirements. When this setup is completed, a therapist may document the e-visit normally, then indicate the appropriate e-visit code based on the cumulative time. The system will automatically roll the time spent providing services into the selected e-visit code.
The HCPCS codes for e-visits are included in the Medicare Physician Fee Schedule. Here is an example of using the Physician Fee Schedule Search tool. (Search for Pricing information for a range of HCPCS codes for your specific locality.)
Here is an example search for the e-visit codes for Portland, OR:
Insight EMR and InsightGO will be updated to support e-visit charge capture. When the new codes and billing rules are in place, just document the services provided remotely along with the appropriate e-visit code indicating the cumulative minutes spent providing the service over a 7-day period. The system will automatically roll the minutes spent providing traditional services into the selected e-visit code.
In this example, the therapist provided exercise instruction, neuromuscular re-education, therapeutic activities and some ADL training during the virtual visit.
The therapist documented those services as they would normally but added the e-visit procedure indicating that between 11 and 20 cumulative minutes were spent providing services.
The system automatically rolled the standard CPT codes into the e-visit HCPCS code.
For more information, please see https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
The information provided herein is intended to be general in nature. It is not offered as legal or insurance related advice, and is not a complete description, or meant, or intended, to replace or be interpreted as specific, of Medicare requirements. Although every effort has been made to ensure the content herein is correct, we assume no responsibility for its accuracy. Contact Department of Health & Human Services (DHHS) Centers for Medicare and Medicaid (CMS) Services for more information.