Can you bill a 99214 for telephone visit?
Asked by: Jessica Shields | Last update: April 22, 2025Score: 4.3/5 (1 votes)
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.
Can you bill for a telephone visit?
You can bill audio-video or audio-only telehealth visits as if they were provided in-person. Physician office telehealth visit payment rates will remain the same as in-person. You can provide telehealth services if you are eligible to bill Medicare for services.
Can you bill 99213 for a telehealth visit?
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 E&M code for a telephone visit?
How is an office visit conducted via audio-video billed? 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.
How to Bill and Code for a Telemedicine Visit During the COVID-19 Pandemic
Can you bill a 99214 for a 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 is required for a 99214 E&M?
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.
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.
Are telehealth visits billed differently?
Medi-Cal pays the same rate for professional medical services provided by telehealth as it pays for services provided in-person. Please see the Payments and Claims section on this page.
What is the CPT code for a 15 minute phone call?
98966: 5-10 minutes. 98967: 11-20 minutes. 98968: 21-30 minutes.
Does UHC cover audio only telehealth?
Urgent, on-demand health care delivered through live audio with video conferencing or audio only technology for treatment of acute but non-emergency medical needs. Covered on the same basis and to the same extent as covered health care services delivered in-person.
Can a doctor bill you for a phone call?
Phone calls must be long enough: The phone call also has to be long enough for doctors to bill for it. It might have to be as long as five minutes before they will be compensated.
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.
Can you bill 99214 twice in one day?
Documentation must be submitted with the claim to medically justify two services on the same day. The frequency restriction for CPT codes 99211 thru 99214 may be exceeded with medical justification.
Can you bill 99214 for observation?
The patient remains in observation status on Friday. At that time, you document a detailed history, detailed exam and moderate-complexity medical decision making. The patient is discharged on Saturday. The correct codes for these services are 99219 (Thursday), 99214 (Friday) and 99217 (Saturday).
How to bill for telephone visits?
Append CPT modifier 93 to services provided via audio-only. Federally qualified health centers and rural health centers should use modifier FQ, 93, or both where appropriate and true, since they are identical in meaning.
Is telephone considered telehealth?
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.
Does Medicare cover telephone only visits?
Additionally, Medicare will pay for audio-only (i.e. telephone services) for specific services (telephone evaluation and management, behavioral health counseling, or educational services). A list of these audio-only services is included in the Appendix at the end of this document.
What are the rules for 99214?
CPT code 99214 should only be used if the patient's medical record documentation supports the criteria for a level 4 visit, including history, examination, and medical decision-making. If the patient's documentation does not meet these criteria, the medical coder should not use CPT code 99214.
Do I need a modifier for 99214?
Does 99214 need a modifier? Modifiers can be used with 99214 if applicable. For example, you can add Modifier 25 to the E/M visit with 99214 if there was a “separately identifiable E/M on the same day of a procedure” (source: ACC). Or add modifier 22 if the procedure was extra complex.
What is a complex office visit?
Complex visits are defined as those with over two diagnoses (the mean of diagnoses made per visit) and/or those with over three prescription medications (the mean of medications prescribed per visit).
Is 99214 a wellness visit?
CPT Code 99214 is used for office or outpatient visits involving established patients with moderately complex medical issues. It typically involves a detailed history, comprehensive examination, and moderate complexity in medical decision-making.
What is considered an office visit?
An office visit is any direct personal exchange between an ambulatory patient and a physician or members of their staff for the purpose of seeking care and rendering health services.
Can you bill an E&M code with a procedure?
CPT and Medicare reimbursement rules allow the reporting of an E/M service when the service is either a significant, separate service or leads to the decision to operate or perform a procedure.