Can you bill 99213 for telehealth visit?
Asked by: Dr. Rudy White | Last update: August 10, 2025Score: 4.2/5 (30 votes)
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 ...
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.
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.
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.
Navigating Telehealth Visits Post-PHE: Changes, Requirements, and Billing
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.
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.
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 type of visit is telehealth?
Technologies for telehealth include videoconferencing, store-and-forward imaging, streaming media, and terrestrial and wireless communications. Telehealth services may be billed and paid differently, depending on the payer/insurer you're working with and your geographic location.
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 to code a telehealth visit?
- 99202-99205: Office/outpatient E/M visit, new patient.
- 99211-99215: Office/outpatient E/M visit, established patient.
- G0425-G0427: Consultations, emergency department or initial inpatient (Medicare only)
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.
What is the 7 day telehealth rule?
The communication cannot be related to a medical visit within the previous seven days and cannot lead to medical visit within the next 24 hours (or soonest appointment available). Physician or other clinician may respond to patient by telephone, audio/video, secure text messaging, email, or patient portal.
What are the rules for 99213?
- Medical Necessity: Healthcare providers need to explain why the visit was needed. ...
- Time-based Documentation: Providers need to spend 20-29 minutes with the patient, which is surely required to help them with decision-making.
Can you bill a 99214 for telephone visit?
For the duration of the public health emergency, CMS and some private payers are allowing audio-only telephone calls to be billed in the same way as in-person visits and these visits will be paid in equivalent amounts as E&M codes 99212-99214.
What are the rules for billing 99214?
- Medical Necessity. ...
- Present Illness Documentation. ...
- Chief Complaint. ...
- Review Symptoms. ...
- Detailed Physical Exam. ...
- Past, Family and Social History. ...
- In-depth History. ...
- Medical Decision Making.
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.
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- ...
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 CPT code for 99213 for telemedicine?
During the COVID-19 public health emergency, many physiatrists are performing standard office visits via telehealth. These services should be billed using standard E/M codes. For example, a level 3 office visit provided to an established patient via telehealth should be billed using code 99213.
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.
Does Medicare pay for 99213?
Medicare will pay a physician for an AWV service and a medically necessary service, e.g. a mid-level established office visit, Current Procedural Terminology (CPT) code 99213, furnished during a single beneficiary encounter.