Coding a telehealth visit
NOTE: CMS is currently processing telemedicine claims based on its new guidance, however this process could be delayed or require additional clarification from your Medicare Administrative Contractor (MAC). Please reach out to your MAC for further guidance.
Teledermatology services can be performed in one of two ways:
Store and forward (asynchronous): Patient submits an image or pre-recorded video for the physician to review and provide advice, e.g., a patient sends a digital image of a lesion to the physician.
Live interactive (synchronous): Real-time two-way interaction between the physician and patient e.g., patient initiates a video chat with the physician to discuss a rash.
The AAD has created a downloadable flowchart to help you distinguish between and code these visits, along with a downloadable coding guide. Keep reading below for more guidance on how to use these documents.
Non-face-to-face (virtual) services are those services that would typically be rendered in-person directly to a patient (or via guardian), but instead are provided using online communication, real-time two-way audio/video platforms, email, EHR portals etc.
Patient initiated: A request for service from the patient. The virtual encounter (electronic communication) may be started by the dermatologist or the patient.
Dermatologists can also provide telehealth consultation services when advice is requested by another physician and delivered virtually without seeing the patient in question face-to-face. Consultation services provided between physicians are reported with inter-professional consultation codes 99446 - 99449 with place of service (POS) code 11 (office setting).
Virtual visits can also be based on medical decision making or time rather than documentation of history and/or physical exam in the medical record.
Medicare virtual check-ins
Medicare pays separately for brief communications or virtual check-in (short patient-initiated communications with a dermatologist or non physician clinician) reported with one of the “G” codes described below. It is important to note that new guidance released by CMS on March 30, 2020 has waived the established patient requirement for G2010 and G2012.
G2010 (asynchronous) - A Medicare patient sends a digital image to his/her physician for evaluation.
G2012 (synchronous) - A brief virtual check-in used for triage of a concern from a Medicare patient. A virtual check-in is a 5-10 minute live-video real-time two-way interaction between the patient and the dermatologist to determine if an in-person visit is necessary.
Place of service code and modifier usage
The use of telehealth codes comes with new terminology and coding concepts. Medicare telehealth services should all be reported with place of service (POS) code 11 and modifier 95 to indicate the encounter was performed via telehealth. These include CPT codes 99201 – 99215; 99421 – 99423; 99441 – 99443; 99446 – 99449; 99451 – 99452; G2010 – G2012. You should consult with your private payers on which modifiers or place of service codes they require.
Dermatologists and non-physician clinicians can now provide telehealth services from their home while continuing to bill from their currently enrolled practice location.
A teledermatology synchronous service rendered via a real-time two-way interactive audio and video telecommunications system that lasts more than a virtual check-in (5-10 minutes) can be reported using the E/M service codes 99201 – 99215.
Other telehealth services
Dermatologists and non-clinician providers can provide virtual encounters to Medicare beneficiaries in the following settings:
Emergency Department: CPT codes 99281-99285
Domiciliary, Rest Home, or Custodial Care services (New and Established patients): CPT codes 99327- 99328; CPT codes 99334-99337
Home Visits, (New and Established Patient): CPT codes 99341- 99345; CPT codes 99347- 99350
Medicare is now allowing the reporting of telehealth services rendered via telephone only when provided to Medicare beneficiaries. Payment for telephone only encounters (CPT codes 99441 - 99443) will be reimbursed at the same rate as established patient E/M codes 99212 - 99214.
Example (rates based on national MPFS; please check your local MPFS for the exact reimbursement rate in your locality)
|Telephone CPT Code||Established Patient E/M Code||National MPFS Rate*|
Private payer requirements
As reporting requirements continue to evolve during this time, we recommend you contact all private payers you work with to ensure you are fulfilling their telehealth coverage policies. The AAD is collecting information on these policies.
Code a visit: Quick coding guide
Download Medicare and private/commercial payer guidance on telemedicine coding for dermatologists.Download coding help
Note: The AAD has based its coding resources and education efforts on CPT guidelines. Times associated with E/M levels are based on the current CPT code descriptors and guidelines.