Can you bill 99213 for a telehealth visit?
Asked by: Dr. Bennie Purdy IV | Last update: September 26, 2025Score: 4.3/5 (51 votes)
Can you use CPT 99213 for telehealth?
Regardless of whether your provider's service meets the requirements for a telephone or office evaluation, you'll receive about the same payment. During the pandemic, CMS has valued 99441-99443 the same as 99213-99215, meaning 99441 pays the same as 99213.
Can you bill and office visit for a telehealth?
E-Consults: A health care provider at the distant site may bill for an e-consult with the CPT Codes listed in the Medi-Cal Telehealth Provider Manual when the benefits or services delivered meet the procedural definition and components of the CPT code for e-consults as defined by the AMA as well as any requirements ...
What are the rules for CPT code 99213?
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.
Can 99214 be used for a telehealth visit?
Remember, you must write down the time: For example, either 9:00 to 9:25, or 25 minutes (99214). On the other hand, do not forget that until Jan. 1, 2021, if you fulfill two-thirds of the key factors — history, physical examination and medical decision-making — you can still use 99214 with proper documentation.
How to Bill and Code for a Telemedicine Visit During the COVID-19 Pandemic
When to bill 99213 vs 99214?
The primary difference between CPT code 99213 and 99214 lies in the complexity and time involved. While 99213 is for a low level of medical decision-making, 99214 is used for moderate complexity, requiring a higher level of medical decision-making and more extensive history and examination.
What is the E&M code for telehealth visits?
Office visit evaluation and management services (CPT codes 99202-99205, 99211-99215) furnished using audio-video telecommunications technology are reported using the same CPT codes as you would have had the visit been conducted in-person.
What is an example of a 99213 visit?
An example of a 99203 or 99213 is a sinus infection treated with an antibiotic. Although the prescription makes the risk component moderate, the one acute uncomplicated illness is a low-complexity problem, and there are no data points.
Can you bill 99213 with modifier 25?
If the E/M is not bundled into the stress test, then the Cardiologist's coder can use modifier 25 to indicate that these two services were separate and significant: 99213-25, 93015.
Is 99213 a preventive code?
However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.
Do you use 95 or GT modifier for telehealth?
The two most commonly used modifiers are the GT modifier for telehealth service rendered via interactive audio and video telecommunications systems, and the 95 modifier for synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
Is telehealth the same as office visit?
Telehealth — sometimes called telemedicine — lets you see your health care provider without going to their office. You can have a telehealth visit online using your computer, tablet, or smartphone. Telehealth care allows you to: Talk with your health care provider on the phone or using video.
How should telehealth visits be billed?
Coding for Audio-video Visits
Use the POS that aligns with the patient's location. As of January 1, 2024, Medicare pays telehealth services provided in the patient's home (POS 10) at the non-facility rate. Telehealth services provided at an originating site (POS 02) are paid at the facility rate.
What code is used for telehealth?
Place of Service codes: When billing telehealth claims, it is important to understand the place of service (POS) codes as it affects reimbursement. POS 02 refers to telehealth provided other than in patient's home and POS 10 refers to telehealth provided in patient's home.
When should 99213 be billed?
Evaluation and Management Codes: New vs Established Clients
Unlike 99212 through 99215, 99202 through 99205 describe newly established clients being seen for evaluation and management services. Code 99213 should only be used with established clients you have already seen for an intake session (CPT Code 90792).
What is the modifier 25 for telehealth?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
Can you bill 99213 and 20610 together?
Per CCI edits, CPT codes 20610-RT and 99213-25 cannot be billed together; however a modifier is allowed with supporting documentation.
How to code a 99213?
- Provide an Expanded Problem-Focused History. ...
- Thoroughly Document the Expanded Problem-Focused Examination. ...
- Detail the Medical Decision Making of Low Complexity. ...
- Document Face-to-Face Time and Direct Interaction. ...
- Use Specific and Descriptive Language.
What is the difference between 99213 and 99214 billing?
An expanded problem-focused history, consistent with a 99213, requires one to three HPI elements while a detailed history consistent with a 99214 requires four or more HPI elements.
How to document a telehealth visit?
- Telehealth Platform: Document in a patient's medical record which method of telemedicine was used. ...
- Remote Location: Make sure to note where the patient is physically located. ...
- Informed Consent: Be sure to obtain consent from a patient before initiating a telemedicine appointment.
Which of the following visits may be appropriate for telehealth?
Final answer: Telehealth is appropriate for follow-ups on medication adjustments, patient education, and reviewing lab results. However, physical examinations and assessments of new pain symptoms typically require in-person visits.
What is the CMS policy on telehealth?
As provided in 42 CFR 425.613(d), CMS monitors and audits the use of telehealth services by ACOs and their ACO participants and reserves the right to take compliance action, up to and including termination of the participation agreement, as specified in §§ 425.216 and 425.218, with respect to an applicable ACO for non- ...