Important Notes to Bulletin #34
March 18, 2022. This Bulletin was updated to correct a procedure code in Section C.1.i regarding telepsychiatry.
SPECIAL BULLETIN COVID-19 #34 replaces the following Medicaid Bulletins in their entirety:
- SPECIAL BULLETIN COVID-19 #9: Telehealth Provisions – Clinical Policy Modification
- SPECIAL BULLETIN COVID-19 #19: Telehealth Provisions – Clinical Policy Modification
- SPECIAL BULLETIN COVID-19 #28: [ADDENDUM to Bulletin #9 Effective March 20, 2020] : Telehealth Provisions – Clinical Policy Modification
Please note the change to F. Place of Service: Telemedicine and telepsychiatry claims should be filed with the provider’s usual place of service code per the appropriate clinical coverage policy and not Place of Service (POS) 02 (telehealth).
Please note the clarification that licensed psychologists and licensed psychological associates are permitted bill using codes for psychiatric diagnostic evaluation and psychotherapy. This was originally listed as “psychologists.”
New telehealth codes and guidance in Bulletin #34:
- Services delivered through local education agencies (LEAs)
- Services delivered through children’s developmental service agencies (CDSAs)
- Diabetes self-management education
- Dietary evaluation and counseling
- Medical lactation
- Research-based behavioral health treatment for autism spectrum disorder
Contents
Background and General Guidance
Definitions
Telehealth Services
- General Policy Modifications
- Local Education Agencies (LEAs)
- Children’s Developmental Services Agencies (CDSAs) – NC Infant Toddler Program (NC ITP) Services
- Diabetes Self-Management Education (DSME)
- Dietary Evaluation and Counseling
- Medical Lactation
- Research-Based Behavioral Health (RB-BHT) Treatment for Autism Spectrum Disorder (ASD)
Virtual Patient Communication Services
Temporary Modifications to Attachment A: Claims-Related Information
- A. Claim Type
- B. International Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) and Procedural Coding System (PCS)
- C. Code(s)
- C.1. Telemedicine, Telepsychiatry and Virtual Patient Communications
- C.2. Local Education Agencies
- C.3. CDSA Coding Guidance - the following codes, when provided via telehealth (real-time audio/video), can be billed by CDSAs
- C.4. Diabetes Self-Management Education Coding Guidance
- C.5. Dietary Evaluation and Counseling Coding Guidance
- C.6. Medical Lactation Coding Guidance
- C.7. Research-Based Behavioral Health Treatment for Autism Spectrum Disorder Coding Guidance
- C.8. HCPCS Codes
- C.9. Revenue Codes
- C.10. Unlisted Procedure or Service
- D. Modifiers
- E. Billing Unit
- F. Place of Service
- G. Copayments
- H. Reimbursement
Background and General Guidance
NC Medicaid, in partnership with the DHHS Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS), has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid and State-funded beneficiaries. These temporary changes are retroactive to March 10, 2020, and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded, unless noted otherwise below. When the temporary modifications end, all face-to-face service requirements will resume.
Providers must ensure that Medicaid services outlined in this and other telehealth COVID-19 clinical policy bulletins can be safely and effectively delivered using telehealth in alignment with relevant NC Medicaid clinical coverage policies. Providers must consider a client’s behavioral, physical and cognitive abilities to participate in services provided using telehealth. The beneficiary’s safety must be carefully considered for the complexity of the services provided.
In addition, in situations where a caregivers or facilitators are necessary to assist with the delivery of telehealth services, their ability to assist and their safety should also be considered. Delivery of services using telehealth must conform to professional standards including but not limited to ethical practice, scope of practice, and other relevant federal, state and institutional policies and requirements including Practice Act and Licensing Board rules.
NC Medicaid has considered the recommendations of related licensing boards and associations and conducted a close evaluation of in-person service codes to develop the policy modifications outlined in this bulletin.
NC Medicaid and DMHDDSAS continue to evaluate telehealth policies and will release temporary flexibilities and guidance as needed throughout the state of emergency.
Specific guidance related to billing and coding is detailed in the section “Temporary Modifications to Attachment A.”
Definitions
- Telehealth is the use of two-way real-time interactive audio and video to provide care and services when participants are in different physical locations. There are three types of telehealth:
- Telemedicine is the use of two-way real-time, interactive audio and video to provide and support health care when participants are in different physical locations.
- Telepsychiatry is the use of two-way real-time, interactive audio and video to provide and support psychiatric/behavioral health care when participants are in different physical locations.
- Teletherapy is the use of two-way real-time, interactive audio and video to provide and support specialized outpatient therapy care when participants are in different locations.
- Virtual Patient Communication is the use of technologies other than video to enable remote evaluation and consultation support between a provider and a patient or a provider and another provider. Covered virtual patient communication services include telephone conversations (audio only); virtual portal communications (e.g., secure messaging); and store and forward (e.g., transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).
Telehealth Services
Consistent with its existing policy, telehealth services (telemedicine, telepsychiatry and teletherapy) have coverage and payment parity with in-person care. Medicaid and NC Health Choice will continue to cover and reimburse all telemedicine interactions at a rate that is equal to in-person care as long as they meet the standard of care and are conducted over a secure HIPAA-compliant technology with live audio and video capabilities.
The following are policy modifications related to telehealth:
- Eligible Technologies
- NC Medicaid has eliminated the restriction that telehealth services cannot be conducted via “video cell phone interactions.” These services can now be delivered via any HIPAA-compliant, secure technology with audio and video capabilities, including (but not limited to) smart phones, tablets and computers.
- In addition, the Office of Civil Rights (OCR) at Health and Human Services (HHS) recently issued guidance noting that “covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency.”
- Service Sites
- Originating Site: There are no restrictions on originating sites (formerly known as spoke sites). Originating sites may include health care facilities, school-based health centers, community sites, the home or wherever the patient may be located.
- Distant Site: There are no restrictions on distant sites (formerly known as hub sites). Distant sites may be wherever the provider may be located. Providers must ensure that patient privacy is protected (e.g., taking calls from private, secure spaces; using headsets). Federally Qualified Health Centers (FQHCs), FQHC Look-Alikes and Rural Health Centers (RHCs) are considered eligible distant sites and should follow the coding and billing guidelines in “Temporary Modifications to Attachment A” below.
- Providers
- Referring Providers: There are no longer any requirements related to referring providers.
- Eligible Providers: NC Medicaid has expanded the list of eligible distant site telemedicine and telepsychiatry providers to include clinical pharmacists, licensed clinical social workers (LCSW), licensed clinical mental health counselors (LCMHCs), licensed marriage and family therapists (LMFTs), licensed clinical addiction specialists (LCASs) and licensed psychological associates (LPAs).
- Authorization, Referrals and In-Person Examinations
- Patients are not required to obtain prior authorization or have an initial in-person examination prior to receiving telemedicine or telepsychiatry services; however, when establishing a new relationship with a patient via either telemedicine or telepsychiatry, the provider must meet the prevailing standard of care and complete all appropriate exam requirements and documentation dictated by E/M coding guidelines.
Local Education Agencies (LEAs)
The following are policy modifications related to services delivered by LEAs to Medicaid beneficiaries in alignment with outpatient specialized therapies policy 10C, Local Education Agencies:
- Eligible Services
- NC Medicaid requirements and standards for services delivered by LEAs are not modified when Medicaid-covered services are delivered via telehealth during the state of emergency.
- A select set of skilled interventions provided by LEAs may be delivered to Medicaid beneficiaries via telemedicine/telepsychiatry/teletherapy as a result of this clinical policy modification, including physical therapy, speech and language therapy, occupational therapy, audiology, psychological and counseling services.
- All psychological testing components and other therapeutic, psychological and counseling services may not be appropriate for telehealth delivery in all situations or for all student beneficiaries. Each student and situation must be assessed individually by the practitioner to determine if telehealth is appropriate and how to safely implement within regulation, scope of practice and policy.
See “Temporary Modifications to Attachment A” for a list of LEA service codes that can be billed as telehealth services, and additional coding and billing guidance.
Children’s Developmental Services Agencies (CDSAs) – NC Infant Toddler Program (NC ITP) Services
The following are policy modifications related to Medicaid-covered NC ITP services delivered by CDSAs and their contract providers:
- Eligible Services
- NC Medicaid requirements and standards for NC ITP services provided by CDSAs in conjunction with contract providers are not modified when Medicaid-covered services are delivered via telehealth during the state of emergency.
- A select set of NC ITP services may be delivered to Medicaid beneficiaries via telehealth as a result of this clinical policy modification, including audiology, nutrition services, occupational therapy, physical therapy, psychological services, speech and language therapy, medical services, clinical social work, multidisciplinary evaluations and assessments, case management, community-based rehabilitative services (CBRS), and developmental testing.
- The delivery of outpatient specialized therapies (physical, occupational, speech and language, audiology) via teletherapy are subject to guidance outlined in Special Bulletin COVID-19 #36.
- Eligible Providers
- The following CDSA staff and their contract providers are eligible to deliver NC ITP services to new or established patients via telehealth: infant, toddler and family specialists, educational diagnosticians, speech and language therapists, audiologists, occupational therapists, physical therapists, psychologists, licensed psychological associates, licensed clinical social workers, licensed clinical mental health counselors (formerly licensed professional counselors), licensed marriage and family therapists, registered nurses, nurse practitioners (including psychiatric nurse practitioners), pediatricians, registered dieticians, nutritionists, registered dieticians, physicians, and physicians assistants.
- Prior Authorization
- Prior authorization requirements for services delivered in-person will still apply when delivered via telehealth. NC ITP telehealth services can be provided under existing prior authorizations.
See “Temporary Modifications to Attachment A” for a list of NC ITP service codes that can be billed as telehealth services, and additional coding and billing guidance.
Diabetes Self-Management Education (DSME)
The following are policy modifications related to DSME services:
- Eligible Services
- DSME can be delivered via telehealth to new or established patients during the COVID-19 public health emergency. All DSME services delivered remotely should follow the specific requirements, standards and guidance included in the NC Medicaid Diabetes Outpatient Self-Management Education Clinical Coverage Policy 1A-24.
- Eligible Providers
- The following non- practitioner providers that typically provide DSME services are eligible to deliver these services via telehealth: certified diabetes educators (CDEs), registered nurses, behaviorists who are Ed.D. prepared, and registered dieticians who are employed by physicians or entities.
- Diabetes education services delivered via telehealth by Non practitioner providers must be billed by one of the following eligible physician practitioners/sites: physicians, nurse practitioners, physicians’ assistants, certified nurse midwives, clinical pharmacists’ practitioners, hospital outpatient departments, local health departments, federally qualified health centers, and rural health centers. These physician practitioners/sites are also eligible to deliver DSME via telehealth directly to patients (in lieu of a non-physician practitioner noted above).
See “Temporary Modifications to Attachment A” for additional coding and billing guidance related to DSME.
Dietary Evaluation and Counseling
The following are policy modifications related to dietary evaluation and counseling services.
- Eligible Services
- Dietary evaluation and counseling services can be delivered via telehealth modalities to new or established patients during the COVID-19 public health emergency. All dietary and counseling services delivered remotely should follow the specific requirements, standards, and guidance included in the NC Division of Medical Assistance Dietary Evaluation and Counseling and Medical Lactation Services Clinical Coverage Policy 1I.
- Eligible Providers
- The following providers may deliver dietary evaluation and counseling services via telehealth: licensed dieticians, licensed nutritionists and registered dieticians.
See “Temporary Modifications to Attachment A” for additional coding and billing guidance related to dietary evaluation and counseling.
Medical Lactation
The following are policy modifications related to medical lactation services.
- Eligible Services
- Medical lactation services can be delivered via telehealth to new or established patients during the COVID-19 public health emergency. All medical lactation services delivered remotely should follow the specific requirements, standards and guidance included in the NC Division of Medical Assistance Dietary Evaluation and Counseling and Medical Lactation Services Clinical Coverage Policy 1I.
- Eligible Providers
- The following providers may deliver medical lactation services via telehealth: physicians, certified nurse midwives, nurse practitioners, physician assistants and international board-certified lactation consultants (IBCLC).
See “Temporary Modifications to Attachment A” for additional coding and billing guidance related to medical lactation.
Research-Based Behavioral Health (RB-BHT) Treatment for Autism Spectrum Disorder (ASD)
The following are policy modifications related to research-based treatment for autism.
- Eligible Services
- Researched-based treatment for autism spectrum disorder can be delivered via telehealth to new or established patients during the COVID-19 public health emergency. All RB-BHT ASD services delivered remotely should follow the specific requirements, standards and guidance included in the NC Medicaid Research-Based Behavioral Health Treatment for Autism Spectrum Disorder Clinical Coverage Policy 8F.
- Eligible Providers
- The following providers may deliver RB-BHT ASD via telehealth:
- Licensed Qualified Autism Service Providers (LQASP): physicians, developmental or behavioral pediatricians, licensed psychologists, licensed psychological associates, occupational therapists, speech and language therapists, licensed clinical social workers, licensed clinical mental health counselors (formerly licensed professional counselors), and licensed marriage and family therapists; or
- Providers of Research-Based Behavioral Health Treatment when those services are delivered by:
- A Certified – Qualified Professional, or
- A Technician under the supervision of a LQASP.
- Prior authorization
- Prior authorization requirements for RB-BHT ASD services delivered in-person will still apply when delivered via telehealth.
See “Temporary Modifications to Attachment A” for additional coding and billing guidance related to RB-BHT ASD.
Virtual Patient Communication Services
NC Medicaid has issued new guidance and codes for the delivery of virtual patient communication services.
- 99421 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
- 99422 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
- 99423 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
Online digital E/M services require physician or other qualified health care professional (QHP) evaluation, assessment and management of the patient. QHP providers are nurse practitioners, physician assistants, certified nurse midwives, and clinical pharmacist practitioners. These services are not for the non-evaluative electronic communication of test results, scheduling of appointments or other communication that does not include E/M. Patients initiate online digital E/M services through HIPAA-compliant, secure platforms such as electronic health record (EHR) portals, secure email or other digital application.
See “Temporary Modifications to Attachment A” for additional coding and billing guidance.
Interprofessional Consultations (QHP to MD)
- 99446 - Interprofessional telephone/internet/electronic health records assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review.
- 99447 - Interprofessional telephone/internet/electronic health records assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 11-20 minutes of medical consultative discussion and review.
- 99448 - Interprofessional telephone/internet/electronic health records assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 21-30 minutes of medical consultative discussion and review.
- 99449 - Interprofessional telephone/internet/electronic health records assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 31 minutes or more of medical consultative discussion and review.
Temporary Modifications to Attachment A: Claims-Related Information
Retroactive to March 10, 2020, through the conclusion of the state of emergency related to COVID-19, NC Medicaid is temporarily modifying Attachment A of its Telemedicine and Telepsychiatry Clinical Coverage Policy 1-H to better enable the delivery of remote care to Medicaid beneficiaries. Provider(s) shall comply with the “NCTracks Provider Claims and Billing Assistance Guide,” Medicaid Bulletins, fee schedules, NC Medicaid’s clinical coverage policies and any other relevant documents for specific coverage and reimbursement for Medicaid and NC Health Choice.
Professional (CMS-1500/837P transaction)
Institutional (UB-04/837I transaction)
Provider(s) shall report the ICD-10-CM and Procedural Coding System (PCS) to the highest level of specificity that supports medical necessity. Provider(s) shall use the current ICD-10 edition and any subsequent editions in effect at the time of service. Provider(s) shall refer to the applicable edition for code description, as it is no longer documented in the policy.
Provider(s) shall report the most specific billing code that accurately and completely describes the procedure, product or service provided. Provider(s) shall use the Current Procedural Terminology (CPT), Health Care Procedure Coding System (HCPCS) and UB-04 Data Specifications Manual (for a complete listing of valid revenue codes) and any subsequent editions in effect at the time of service. Provider(s) shall refer to the applicable edition for the code description, as it is no longer documented in the policy.
If no such specific CPT or HCPCS code exists, then the provider(s) shall report the procedure, product or service using the appropriate unlisted procedure or service code.
Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) may bill for telehealth, telepsychiatry and select virtual patient communication services if the service follows core service billing requirements as outlined in clinical coverage policy 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics. Information concerning Virtual Communication Services provided by FQHCs and RHCs is located here: https://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center.
Note: Codes billable by FQHCs and RHCs are identified with a plus sign (+).
C.1. Telemedicine, Telepsychiatry and Virtual Patient Communications
C.1.a. The following new and established patient office or other outpatient service and office and inpatient consultation codes, when provided via telemedicine or telepsychiatry, may be billed by physicians, nurse practitioners (including psychiatric), physician assistants, advanced practice midwives and clinical pharmacist practitioners.
|
Codes |
||
|
99201 99202 99203 99204 99205 99211 99212 |
99213 99214 99215 99241 99242 99243 99244 |
99245 99251 99252 99253 99254 99255 T1015+ |
C.1.b. The following online digital evaluation and management codes may be billed by physicians, physician assistants, nurse practitioners, advance practice midwives, FQHCs, FQHC Look-Alikes and RHCs.
|
Codes |
|
99421+ 99422+ 99423+ |
C.1.c. The following telephonic evaluation and management and virtual patient communication codes may be billed by physicians, physician assistants, nurse practitioners and advance practice midwives.
|
Codes |
|
|
99441 99442 99443 |
G0071+ G2012 |
C.1.d. The following interprofessional assessment and management codes may be billed by physicians only.
|
Codes |
|
|
99446 99447 |
99448 99449 |
C.1.e. The following psychiatric diagnostic evaluation and psychotherapy codes, when provided by telepsychiatry, may be billed by licensed clinical addiction specialists, licensed clinical mental health and professional counselors, licensed psychologists, licensed psychological associates, licensed clinical social workers, licensed marriage and family therapists, physicians, and psychiatric nurse practitioners.
NOTE: Psychiatric diagnostic evaluation and psychotherapy codes 90792, 90833, 90836, and 90838, marked with an asterisk (*) can only be billed by licensed psychiatric prescribing providers (physicians, physician assistants and nurse practitioners) as outlined in CCP 8C Section 6.1.
|
Codes |
||
|
90791 90792* 90832 90833* 90834 90836* |
90837 90838* 90839 90840 90846 90847 |
90849 90853 90785 T1015-HI+ |
C.1.f. The following behavioral health testing and screening codes may now be billed by appropriate licensed clinicians (as outlined in CCP 8C) using telepsychiatry (real time two-way audio/video). Psychiatrists/physicians, psychiatric nurse practitioners, physician assistants, licensed psychologists and licensed psychological associates may bill the code in the table below. Please note, the qualified testing professional should be aware that many current developmental, psychological and neuropsychological tests do not have normative groups for tests administered virtually or via telehealth and, as such, test results may need to be interpreted with caution. See the following APA link for guidance: https://www.apa.org/practice/guidelines/telepsychology.
|
Codes |
|
96110 |
C.1.g. The following behavioral health testing and screening codes may now be billed by appropriate licensed clinicians (as outlined in CCP 8C) using telepsychiatry (real time two-way audio/video). Psychiatrists/physicians, licensed psychologists and licensed psychological associates may bill the codes in the table below. Please note, the qualified testing professional should be aware that many current developmental, psychological and neuropsychological tests do not have normative groups for tests administered virtually or via telehealth and, as such, test results may need to be interpreted with caution. See the following APA link for guidance: https://www.apa.org/practice/guidelines/telepsychology.
|
Codes |
||
|
96112 96113 96116 96121 96130 |
96131 96132 96133 96136 96137 |
96138 96139 96146
|
C.1.h. The following telephone assessment and management codes may be billed by licensed clinical addiction specialists, licensed clinical addiction specialist associates, licensed mental health and professional counselors, licensed mental health and professional counselor associates, licensed psychologists, licensed psychological associates, licensed clinical social workers, licensed clinical social worker associates, licensed marriage and family therapists, licensed marriage and family therapist associates.
Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) may bill for services provided by licensed clinical addiction specialists, licensed clinical mental health counselors, licensed psychologists, licensed psychological associates, licensed clinical social workers and licensed marriage and family therapists
|
Codes |
|
98966+ 98967+ 98968+ |
C.1.i. The following inpatient professional codes (requiring real-time, two-way audio/video) when provided by telepsychiatry may be billed by licensed psychiatric prescribing providers (MD/DO Psychiatrists and PMHNP-BCs).
|
Codes |
|
|
99231 99232 99233 |
99238 99239 |
C.2. Local Education Agencies
C.2.a. The following new and established patient codes, when provided via telehealth (real-time audio/video), may be billed by physical therapists in LEAs.
|
Description (See 2020 CPT Code Book for Complete Details) |
|
|
97161 |
Physical therapy evaluation: low complexity, typically, 20 minutes are spent face-to-face with the patient and/or family. |
|
97162 |
Physical therapy evaluation: moderate complexity; typically, 30 minutes are spent face-to-face with the patient and/or family. |
|
97163 |
Physical therapy evaluation; high complexity; typically, 45 minutes are spent face-to-face with the patient and/or family. |
|
97164 |
Re-evaluation of physical therapy established plan of care; typically, 20 minutes are spent face-to-face with the patient and/or family. |
|
97750 |
Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes. |
|
97110 |
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility |
|
97112 |
Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities. |
|
97116 |
Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing) |
|
97530 |
Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes |
|
97533 |
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes |
|
97535 |
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 |
|
97542 |
Wheelchair management (e.g., assessment, fitting, training), each 15 minutes |
|
97763 |
Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies) and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes |
|
95992 |
Canalith repositioning procedure(s) (e.g., Epley maneuver, Semont maneuver), per day |
C.2.b. The following new and established patient codes, when provided via telehealth, may be billed by occupational therapists in LEAs.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
92065 |
Orthoptic and/or pleoptic training, with continuing medical direction and evaluation |
|
92526 (feeding only) |
Treatment of swallowing dysfunction and/or oral function for feeding (approved for oral function and feeding only) |
|
97165 |
Occupational therapy evaluation, low complexity; typically, 30 minutes are spent face-to-face with patient and/or family. |
|
97166 |
Occupational therapy evaluation, moderate complexity, requiring these components; typically, 45 minutes are spent face-to-face with patient and/or family. |
|
97167 |
Occupational therapy evaluation, high complexity, requiring these components; typically, 60 minutes are spent face-to-face with patient and/or family. |
|
97168 |
Re-evaluation of occupational therapy established plan of care; typically, 30 minutes are spent face-to-face with the patient and/or family. |
|
97750 |
Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes. |
|
97110 |
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility |
|
97112 |
Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities |
|
97116 |
Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing) |
|
97530 |
Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes |
|
97533 |
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes |
|
97535 |
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 |
|
97542 |
Wheelchair management (e.g., assessment, fitting, training), each 15 minutes |
|
97763 |
Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies) and/or trunk, subsequent orthotic(s)/prosthetics(s) encounter, each 15 minutes |
C.2.c. The following new and established patient codes, when provided via telehealth, may be billed by speech language therapists in LEAs.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
92521 |
Evaluation of speech fluency (e.g., stuttering, cluttering) |
|
92522 |
Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); |
|
92523 |
Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) |
|
92524 |
Behavioral and qualitative analysis of voice and resonance |
|
92607 |
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour |
|
92608 |
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes |
|
92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual |
|
92526 (feeding only) |
Treatment of swallowing dysfunction and/or oral function for feeding (approved for oral function and feeding only) |
|
92609 |
Therapeutic services for the use of speech-generating device, including programming and modification |
|
92630 |
Auditory rehabilitation; prelingual hearing loss |
|
92633 |
Auditory rehabilitation; postlingual hearing loss |
|
96125 |
Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report |
C.2.d. The following established patient codes, when provided via telehealth, may be billed by audiologists in LEAs.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
92630 |
Auditory rehabilitation; prelingual hearing loss |
|
92633 |
Auditory rehabilitation; postlingual hearing loss |
C.2.e. The following new and established patient codes, when provided via telehealth, may be billed by the appropriate psychology and/or counseling professional in LEAs per clinical coverage policy 10C.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
90832 |
Psychotherapy, 30 minutes with patient |
|
90834 |
Psychotherapy, 45 minutes with patient |
|
90837 |
Psychotherapy, 60 minutes with patient |
|
90847 |
Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes |
|
96110 |
Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument |
|
96112 |
Developmental test administration (including assessment and fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments with performed), by physician or other qualified health care professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment and fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments with performed), by physician or other qualified health care professional, with interpretation and report; each additional 30 minutes |
|
96130 |
Psychological testing evaluation by qualified health care professional, first 60 minutes |
|
96131 |
Psychological testing evaluation by qualified health care professional, additional 60 minutes |
C.3. CDSA Coding Guidance - the following codes, when provided via telehealth (real-time audio/video), can be billed by CDSAs
C.3.a. The following new and established patient codes, when provided via telehealth, can be billed by occupational therapists.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
92526 (feeding only) |
Treatment of swallowing dysfunction and/or oral function for feeding (approved for oral function and feeding only) |
|
96110 |
Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument |
|
96112 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; each additional 30 minutes |
|
97110 |
Therapeutic procedure, one or more areas, each 15 minutes; therapeutic |
|
97112 |
Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular |
|
97116 |
Therapeutic procedure, one or more areas, each 15 minutes; gait training |
|
97165 |
Evaluation of occupational therapy, typically 30 minutes |
|
97166 |
Evaluation of occupational therapy, typically 45 minutes |
|
97167 |
Evaluation of occupational therapy established plan of care, typically 60 minutes |
|
97168 |
Re-evaluation of occupational therapy established plan of care, typically 30 minutes |
|
97533 |
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes |
|
97535 |
Self-care/home management training (e.g., activities of daily living and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact by provider, each 15 minutes |
|
97542 |
Wheelchair management/propulsion training, each 15 minutes |
|
97750 |
Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes. |
|
97763 |
Management and/or training in use of orthotics (supports, braces or splints for arms, legs and/or trunk, per 15 minutes) |
|
T1023 |
Screening to determine the appropriateness of consideration of an individual |
C.3.b. The following new and established patient codes, when provided via telehealth, can be billed by physical therapists.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
92526 (feeding only) |
Treatment of swallowing dysfunction and/or oral function for feeding (approved for oral function and feeding only) |
|
96110 |
Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument |
|
96112 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; each additional 30 minutes |
|
97110 |
Therapeutic procedure, one or more areas, each 15 minutes; therapeutic |
|
97112 |
Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular |
|
97116 |
Therapeutic procedure, one or more areas, each 15 minutes; gait training |
|
97162 |
Evaluation of physical therapy, typically 30 minutes |
|
97163 |
Evaluation of physical therapy, typically 45 minutes |
|
97164 |
Re-evaluation of physical therapy, typically 20 minutes |
|
97533 |
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes |
|
97535 |
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 |
|
97542 |
Wheelchair management/propulsion training, each 15 minutes |
|
97750 |
Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes. |
|
97763 |
Management and/or training in use of orthotics (supports, braces or splints for arms, legs and/or trunk, per 15 minutes) |
|
T1023 |
Screening to determine the appropriateness of consideration of an individual |
C.3.c. The following new and established patient codes, when provided via telehealth, can be billed by speech and language therapists.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual |
|
92521 |
Evaluation of speech fluency |
|
92522 |
Evaluation of speech sound production and expression |
|
92523 |
Evaluation of speech sound production with evaluation of language comprehension. |
|
92524 |
Behavioral and qualitative analysis of voice and resonance. |
|
92526 (feeding only) |
Treatment of swallowing dysfunction and/or oral function for feeding (approved for oral function and feeding only) |
|
92630 |
Auditory rehabilitation; pre-lingual hearing loss |
|
92633 |
Auditory rehabilitation; post-lingual hearing loss |
|
96110 |
Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument |
|
96112 |
Developmental test administration by physician or other qualified healthcare professional, with interpretation and report; first 60 minutes |
|
96113 |
Developmental test administration by qualified health professional with interpretation and report, additional 30 minutes |
|
T1023 |
Screening to determine the appropriateness of consideration of an individual |
C.3.d. The following new and established patient codes, when provided via telehealth, can be billed by nurse practitioners (including psychiatric nurse practitioners).
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
90832 |
Psychotherapy, 30 minutes with patient |
|
90834 |
Psychotherapy, 45 minutes with patient |
|
90837 |
Psychotherapy, 60 minutes with patient |
|
96112 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; each additional 30 minutes |
|
99211 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are minimal. Approximately 5 minutes |
|
99212 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are self-limited or minor. Approximately 10 minutes |
|
99213 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are of low to moderate severity. Approximately 15 minutes |
|
99214 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are moderate to high severity. Approximately 25 minutes |
|
99215 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are moderate to high severity. Approximately 40 minutes |
|
T1023 |
Screening to determine the appropriateness of consideration of an individual |
C.3.e. The following new and established patient codes, when provided via telehealth, can be provided by registered nurses who are Qualified Professionals (QPs).
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
96112 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; each additional 30 minutes |
|
T1023 |
Screening to determine the appropriateness of consideration of an individual |
C.3.f. The following new and established patient codes, when provided via telehealth, can be billed by audiologists.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
92630 |
Auditory rehabilitation; pre-lingual hearing loss |
|
92633 |
Auditory rehabilitation; post-lingual hearing loss |
|
T1023 |
Screening to determine the appropriateness of consideration of an individual |
C.3.g. The following new and established patient codes, when provided via telehealth, can be provided by educational diagnosticians.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
96110 |
Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument |
|
96112 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; each additional 30 minutes |
|
T1023 |
Screening to determine the appropriateness of consideration of an individual |
C.3.h. The following new and established patient codes, when provided via telehealth, can be billed by licensed psychologists.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
90832 |
Psychotherapy, 30 minutes with patient |
|
90834 |
Psychotherapy, 45 minutes with patient |
|
90837 |
Psychotherapy, 60 minutes with patient |
|
90846 |
Family psychotherapy (without the patient present) |
|
90847 |
Family Psychotherapy (conjoint psychotherapy) (with patient present) |
|
96110 |
Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument |
|
96112 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; each additional 30 minutes |
|
96116 |
Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgement |
|
96121 |
Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes |
|
96130 |
Psychological testing evaluation by qualified health care professional, first 60 minutes |
|
96131 |
Psychological testing evaluation by qualified health care professional, additional 60 minutes |
|
96132 |
Neuropsychological testing evaluation by qualified health care professional, first 60 minutes |
|
96133 |
Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes |
|
H0031 |
Mental health assessment, by non-physician |
|
T1023 |
Screening to determine the appropriateness of consideration of an individual |
C.3.i. The following new and established patient codes, when provided via telehealth, can be billed by licensed clinical mental health counselors (formerly licensed professional counselors), licensed psychological associates, and licensed marriage and family therapists.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
90832 |
Psychotherapy, 30 minutes with patient |
|
90834 |
Psychotherapy, 45 minutes with patient |
|
90837 |
Psychotherapy, 60 minutes with patient |
|
90846 |
Family psychotherapy (without the patient present), 50 minutes |
|
90847 |
Family Psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes |
|
H0031 |
Mental health assessment, by non-physician |
C.3.j. The following new and established patient codes, when provided via telehealth, can be billed by licensed clinical social workers.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
90832 |
Psychotherapy, 30 minutes with patient |
|
90834 |
Psychotherapy, 45 minutes with patient |
|
90837 |
Psychotherapy, 60 minutes with patient |
|
90846 |
Family psychotherapy (without the patient present), 50 minutes |
|
90847 |
Family Psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes |
|
96110 |
Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument |
|
96112 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; each additional 30 minutes |
|
H0031 |
Mental health assessment, by non-physician |
|
T1023 |
Screening to determine the appropriateness of consideration of an individual |
C.3.k. The following new and established patient codes, when provided via telehealth, can be provided by nutritionists.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
96112 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; each additional 30 minutes |
|
97802 |
Medical nutrition therapy, initial assessment and intervention, individual |
|
97803 |
Medical nutrition therapy, re-assessment and intervention, individual |
|
T1023 |
Screening to determine the appropriateness of consideration of an individual |
C.3.l. The following new and established patient codes, when provided via telehealth, can be provided by infant, toddler and family specialists.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
96110 |
Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument |
|
96112 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; each additional 30 minutes |
|
H0036 |
Community psychiatric supportive treatment, face-to-face, per 15 minutes |
|
H0036-HI |
Community based services early children intervention professional, individual, 15 minutes |
|
H0036-HM |
Community based services paraprofessional, individual, 15 minutes |
|
H0036-HQ |
Community based services professional group 2 clients, 15 minutes |
|
H0036-TL |
Community based services, professional, 2 clients, 15 minutes |
|
H0036-UI |
Community based services paraprofessional group 2 clients, 15 minutes |
|
T1017 |
Target case management- early intervention |
|
T1023 |
Screening to determine the appropriateness of consideration of an individual |
C.3.m. The following new and established patient codes, when provided via telehealth, can be billed by physicians.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
Psychotherapy, 30 minutes |
|
|
90834 |
Psychotherapy, 45 minutes |
|
90837 |
Psychotherapy, 60 minutes |
|
96110 |
Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument |
|
96112 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; each additional 30 minutes |
|
96116 |
Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgement |
|
96121 |
Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes |
|
96132 |
Neuropsychological testing evaluation by qualified health care professional, first 60 minutes |
|
96133 |
Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes |
|
99201 |
Office or other outpatient visit for evaluation and management of a new patient. Usually, the problem(s) are self-limited or minor. Approximately 10 minutes- |
|
99202 |
Office or other outpatient visit for evaluation and management of a new patient. Usually, the problem(s) are of low to moderate severity. Approximately 20 minutes |
|
99203 |
Office or other outpatient visit for evaluation and management of a new patient. Usually, the problem(s) are of moderate severity. Approximately 30 minutes |
|
99204 |
Office or other outpatient visit for evaluation and management of a new patient. Usually, the problem(s) are of moderate to high severity. Approximately 45 minutes |
|
99205 |
Office or other outpatient visit for evaluation and management of a new patient. Usually, the problem(s) are of moderate to high severity. Approximately 60 minutes |
|
99211 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are minimal. Approximately 5 minutes |
|
99212 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are self-limited or minor. Approximately 10 minutes |
|
99213 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are of low to moderate severity. Approximately 15 minutes |
|
99214 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are moderate to high severity. Approximately 25 minutes |
|
99215 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are moderate to high severity. Approximately 40 minutes |
|
99241 |
Office consultation for anew or established patient. Usually presenting problem(s) are self-limited or minor. Approximately 15 minutes |
|
99242 |
Office consultation for anew or established patient. Usually presenting problem(s) are of low severity. Approximately 30 minutes |
|
99243 |
Office consultation for anew or established patient. Usually presenting problem(s) are of moderate severity. Approximately 40 minutes |
|
99244 |
Office consultation for anew or established patient. Usually presenting problem(s) are of moderate to high severity. Approximately 60 minutes |
|
99245 |
Office consultation for anew or established patient. Usually presenting problem(s) are of moderate to high severity. Approximately 80 minutes |
|
T1023 |
Screening to determine appropriateness of consideration of an individual |
C.3.n. The following new and established patient codes, when provided via telehealth, can be billed by physician assistants.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
96112 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; each additional 30 minutes |
|
99211 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are minimal. Approximately 5 minutes |
|
99212 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are self-limited or minor. Approximately 10 minutes |
|
99213 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are of low to moderate severity. Approximately 15 minutes |
|
99214 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are moderate to high severity. Approximately 25 minutes |
|
99215 |
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are moderate to high severity. Approximately 40 minutes |
C.3.o. The following new and established patient codes, when provided via telehealth, can be provided by registered dieticians.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
96110 |
Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument |
|
96112 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; first hour |
|
96113 |
Developmental test administration (including assessment of fine motor and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified healthcare professional, with interpretation and report; each additional 30 minutes |
|
97802 |
Medical nutrition therapy, initial assessment and intervention, individual |
|
97803 |
Medical nutrition therapy, re-assessment and intervention, individual |
C.4. Diabetes Self-Management Education Coding Guidance
The following new and established patient codes, when provided via telehealth, can be billed by the following physician practitioners: physicians, nurse practitioners, physician assistant, certified nurse midwives, clinical pharmacist practitioners (CPP), hospital outpatient departments, local health departments, federally qualified health centers/rural health clinics. They may also bill for the DSME services provided by registered nurses, certified diabetes educators, behaviorists who are Ed. D prepared, registered dieticians who are employed by physicians or entities.
|
Code |
Description (See 2020 CPT Code Book for Complete Details) |
|
G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
C.5. Dietary Evaluation and Counseling Coding Guidance
The following new and established patient codes, when provided via telehealth, by dieticians or nutritionists currently licensed by the N.C. Board of Dietetics Nutrition and dieticians registered with the Commission of Dietetic Registration who are employed by physicians, NPs, PAs, CNM, CPPs, hospital outpatient departments, local health departments, federally qualified health centers/rural health clinics.
|
Code |
Description (See 2020 CPT Code Book for Complete Details) |
|
97802 |
Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes. |
|
97803 |
Re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
C.6. Medical Lactation Coding Guidance
The following new and established patient codes, when provided via telehealth, can be billed by physicians, nurse practitioners, physician assistants, certified nurse midwives, nurse practitioners, physician assistants . The services of international board-certified lactation consultants who are employed or contracted by the physician or physician group or have a referral for a consult in another medical practice can be billed by the physician.
|
Code |
Description (See 2020 CPT Code Book for Complete Details) |
|
96156 |
Health behavior assessment, or reassessment (i.e., health-focused clinical interview, behavioral observations, clinical decision making) |
|
96158 |
Health behavior intervention, individual, face-to-face; initial 30 minutes |
|
96159 |
Health behavior intervention, individual, face-to-face; each additional 15 minutes |
C.7. Research-Based Behavioral Health Treatment for Autism Spectrum Disorder Coding Guidance
The following new and established patient codes, when provided via telehealth, can be billed by
- Licensed Qualified Autism Service Providers (LQASP), including: physicians; developmental or behavioral pediatricians; licensed psychologists; licensed psychological assistants; occupational therapists; speech and language pathologists; licensed clinical social workers; licensed clinical mental health counselors (formerly licensed professional counselors), and, licensed marriage and family therapists; or,
- Providers of Research-Based Behavioral Health Treatment when those services are delivered by:
- A Certified – Qualified Professional, or
- A Technician under the supervision of a LQASP.
- See CCP 8F for additional guidance regarding the delivery of these services.
|
Code |
Description (See 2020 CPT Code Book for Complete Details) |
|
97151 |
Behavior Identification Assessment, 15 minutes (Note: Only an individual, entity or group that meets the criteria for an LQASP can provide 97151) |
|
97152 |
Behavior Identification Supporting Assessment, 15 minutes |
|
97153 |
Adaptive Behavior Treatment by Protocol, 15 minutes |
|
97154 |
Group Adaptive Behavior Treatment by Protocol, 15 minutes |
|
97155* |
Adaptive behavior treatment with protocol modification |
|
97156 |
Family Adaptive Behavior Treatment Guidance, 15 minutes |
|
97157 |
Multiple-Family Group Adaptive Behavior Treatment Guidance, 15 minutes |
*In administering 97155, the physician or other qualified health care professional resolves one or more problems with the protocol and may simultaneously direct a technician in administering the modified protocol while the patient is present. Physician or other qualified health care professional direction to the technician without the patient present is not reported separately.
The following HCPCS code can be billed for the Telehealth originating site facility fee by the originating site (the site at which the beneficiary is located): Q3014. Refer to Subsection 6.3 for list of providers.
HCPCS code T1023 can be billed only by diagnostic assessment agencies for screening / evaluation to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter (1 unit = 1 event). T1023 (1 unit) is billed for the date that the total assessment is completed by the agency that employs the providers of service.
When the originating site is a hospital, the originating site facility fee must be billed with RC780 and Q3014.
C.10. Unlisted Procedure or Service
- CPT: The provider(s) shall refer to and comply with the Instructions for Use of the CPT Codebook, Unlisted Procedure or Service, and Special Report as documented in the current CPT in effect at the time of service.
- HCPCS: The provider(s) shall refer to and comply with the Instructions for Use of HCPCS National Level II Codes, Unlisted Procedure or Service and Special Report as documented in the current HCPCS edition in effect at the time of service.
Provider(s) shall follow applicable modifier guidelines.
- Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive audio-visual communication. This modifier is not appropriate for services performed telephonically or through email or patient portal.
- Modifier CR (catastrophe/disaster related) must be appended to all claims for CPT and HCPCS codes listed in this policy to relax frequency limitations defined in code definitions.
Provider(s) shall report the appropriate code(s) used which determines the billing unit(s).
Telemedicine and telepsychiatry claims should be filed with the provider’s usual place of service code per the appropriate clinical coverage policy and not Place of Service (POS) 02 (telehealth).
- For Medicaid, refer to Medicaid State Plan, Attachment 4.18-A, page 1, located at https://medicaid.ncdhhs.gov/.
- For NC Health Choice, refer to G.S. 108A-70.21(d), located at http://www.ncleg.net/EnactedLegislation/Statutes/HTML/BySection/Chapter_108A/GS_108A-70.21.html.
Provider(s) shall bill their usual and customary charges. For a schedule of rates, refer to https://medicaid.ncdhhs.gov/. When the GT modifier is appended to a code billed for professional services, the service is paid at 100% of the allowed amount of the fee schedule.
- For hospitals, this is a covered service for both inpatient and outpatient and is part of the normal hospital reimbursement methodology.
- Reimbursement for these services is subject to the same restrictions as face-to-face contacts (such as place of service, allowable providers, multiple service limitations, prior authorization) unless otherwise noted in this policy.
NC Medicaid Telehealth Billing Code Summary Chart
NC Medicaid Telehealth Resources website
NC Medicaid COVID-19 Resources website