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Telehealth During the COVID-19 Public Health Emergency FAQ

  • Can ED E/M codes be reported using telehealth?

    Recommendations
    Answer

    Yes, during the COVID-19 pandemic, CMS added the ED E/M codes (99281-99285) to the list of approved Medicare telehealth services. This means that these services can be furnished via telehealth—or real time two-way audio and visual interaction. The place of service (POS) code used on the claim should be the same as if the service was rendered face-to face; for the ED that would be POS 23. This is true even if the patient is not physically located in the ED (e.g, patient is in a remote location, including the patient’s home).  It is also allowed that the emergency physician may be in a different location,  including at home.  This policy is retroactive to services provided after March 6, 2020. In the calendar year 2021 physician fee schedule final rule, CMS decided to keep these codes on the list of approved telehealth services through the end of the calendar year in which PHE expires.  However, at the end of the PHE, the geographic rules revert to pre-pandemic locations.  See FAQ 3.

    Answer

    Yes, during the COVID-19 pandemic, CMS added the ED E/M codes (99281-99285) to the list of approved Medicare telehealth services. This means that these services can be furnished via telehealth—or real time two-way audio and visual interaction. The place of service (POS) code used on the claim should be the same as if the service was rendered face-to face; for the ED that would be POS 23. This is true even if the patient is not physically located in the ED (e.g, patient is in a remote location, including the patient’s home).  It is also allowed that the emergency physician may be in a different location,  including at home.  This policy is retroactive to services provided after March 6, 2020. In the calendar year 2021 physician fee schedule final rule, CMS decided to keep these codes on the list of approved telehealth services through the end of the calendar year in which PHE expires.  However, at the end of the PHE, the geographic rules revert to pre-pandemic locations.  See FAQ 3.

  • What documentation requirements are required to bill and ED E/M service via telehealth?

    Recommendations
    Answer

    In general, you should document in the same manner as a face-to-face visit. Consider including the following documentation for your telehealth ED visits:

    1. Document patient consent;
    2. Chief complaint, HPI, past/family/social Hx, review of systems;
    3. Visual physical exam;
    4. Medical decision making such as differential (including COVID concern), any prescriptions, testing or self-monitoring instructions;
    5. Document location of the provider to determine whether the -95 modifier (service furnished via telehealth) will be required.
    Answer

    In general, you should document in the same manner as a face-to-face visit. Consider including the following documentation for your telehealth ED visits:

    1. Document patient consent;
    2. Chief complaint, HPI, past/family/social Hx, review of systems;
    3. Visual physical exam;
    4. Medical decision making such as differential (including COVID concern), any prescriptions, testing or self-monitoring instructions;
    5. Document location of the provider to determine whether the -95 modifier (service furnished via telehealth) will be required.
  • Are there geographic restrictions on the originating site for telehealth?

    Recommendations
    Answer

    There are specific restrictions in place under Section 1834(m) of the Social Security Act that limit where telehealth services may be delivered. Specifically, telehealth services may only be performed in rural areas of the country and from certain health care facilities, requiring Medicare beneficiaries to travel to places such as a physician’s office, skilled nursing facility or hospital for the visit.  However, under the CMS’ 1135 waiver, telehealth services may now be provided in all areas (not just rural), and any Medicare beneficiaries may receive these services from any location, including their homes. This applies to both new patients and those with whom the furnishing physician has a pre-established relationship.  Once the PHE expires, the geographic restrictions return immediately (meaning that telehealth services can only be provided in rural areas once again and beneficiaries must travel to certain facilities to receive the service).

    Answer

    There are specific restrictions in place under Section 1834(m) of the Social Security Act that limit where telehealth services may be delivered. Specifically, telehealth services may only be performed in rural areas of the country and from certain health care facilities, requiring Medicare beneficiaries to travel to places such as a physician’s office, skilled nursing facility or hospital for the visit.  However, under the CMS’ 1135 waiver, telehealth services may now be provided in all areas (not just rural), and any Medicare beneficiaries may receive these services from any location, including their homes. This applies to both new patients and those with whom the furnishing physician has a pre-established relationship.  Once the PHE expires, the geographic restrictions return immediately (meaning that telehealth services can only be provided in rural areas once again and beneficiaries must travel to certain facilities to receive the service).

  • What if the patient does not have internet access or a smart phone?

    Recommendations
    Answer

    During the pandemic, CMS will reimburse for audio-only telephone calls. CMS has temporarily added separate codes (CPT codes 98966-98968 and CPT codes 99441-99443) to the list of approved telehealth services.  The codes are valued the same as the office and outpatient evaluation and management (E/M) codes. Note: Telephone services should not be reported for a follow up call related to a procedure by your same group.

    Answer

    During the pandemic, CMS will reimburse for audio-only telephone calls. CMS has temporarily added separate codes (CPT codes 98966-98968 and CPT codes 99441-99443) to the list of approved telehealth services.  The codes are valued the same as the office and outpatient evaluation and management (E/M) codes. Note: Telephone services should not be reported for a follow up call related to a procedure by your same group.

  • Do EMTALA and HIPAA still apply for a telehealth ED visit?

    Recommendations
    Answer

    An EMTALA mandated medical screening exam may be furnished via telehealth. Telehealth services may be delivered through the use of telephones that have audio and video capabilities. The HHS Office for Civil Rights (OCR) is waiving penalties for Health Insurance Portability and Accountability Act (HIPAA) violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.  For more information: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

    Answer

    An EMTALA mandated medical screening exam may be furnished via telehealth. Telehealth services may be delivered through the use of telephones that have audio and video capabilities. The HHS Office for Civil Rights (OCR) is waiving penalties for Health Insurance Portability and Accountability Act (HIPAA) violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.  For more information: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

  • What other services may be reported using telehealth?

    Recommendations
    Answer

    CMS also allows reporting the critical care services (CPT codes 99291 and 99292), and the observation services (CPT codes 99217-99220, 99224-99226, and 99234-99236) to the list of approved Medicare telehealth services for the duration of the COVID-19 national emergency. CMS is also allowing the majority of these codes to remain on the list for an extended period of time—through the end of the calendar year in which the PHE ends.  However, CMS explicitly decided not to extend a subset of the observation codes: CPT 99218-99220 and CPT 99234-99236.  These codes will be removed from the list immediately once the PHE ends

    Answer

    CMS also allows reporting the critical care services (CPT codes 99291 and 99292), and the observation services (CPT codes 99217-99220, 99224-99226, and 99234-99236) to the list of approved Medicare telehealth services for the duration of the COVID-19 national emergency. CMS is also allowing the majority of these codes to remain on the list for an extended period of time—through the end of the calendar year in which the PHE ends.  However, CMS explicitly decided not to extend a subset of the observation codes: CPT 99218-99220 and CPT 99234-99236.  These codes will be removed from the list immediately once the PHE ends

  • What about virtual check ins and e-visits from the ED?

    Recommendations
    Answer

    Medicare patients may have a brief communication service with practitioners via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image. Clinicians may provide remote evaluation of patient video/images and virtual check-in services (HCPCS codes G2010, G2012) to both new and established patients. These services were previously limited to established patients.

    Licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists may provide e-visits. E-visits are non-face-to-face communications with a practitioner via online patient portals. (HCPCS codes G2061-G2063).

    Clinicians may provide remote patient monitoring services to both new and established patients. These services may be provided for both acute and chronic conditions and may now be provided for patients with only one disease. For example, remote patient monitoring may be used to monitor a patient’s oxygen saturation levels using pulse oximetry. (CPT codes 99091, 99457-99458, 99473-99474, 99493-99494)

    CPT coding guidance states that the remote physiologic monitoring service described by CPT code 99454 (device(s) supply with daily recordings or programmed alerts transmission each 30 day(s)), may not be reported for monitoring of less than 16 days. However, for purposes of treating suspected COVID-19 infections, Medicare will allow the service to be reported for shorter periods of time than 16 days as long as the other code requirements are met.

    Answer

    Medicare patients may have a brief communication service with practitioners via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image. Clinicians may provide remote evaluation of patient video/images and virtual check-in services (HCPCS codes G2010, G2012) to both new and established patients. These services were previously limited to established patients.

    Licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists may provide e-visits. E-visits are non-face-to-face communications with a practitioner via online patient portals. (HCPCS codes G2061-G2063).

    Clinicians may provide remote patient monitoring services to both new and established patients. These services may be provided for both acute and chronic conditions and may now be provided for patients with only one disease. For example, remote patient monitoring may be used to monitor a patient’s oxygen saturation levels using pulse oximetry. (CPT codes 99091, 99457-99458, 99473-99474, 99493-99494)

    CPT coding guidance states that the remote physiologic monitoring service described by CPT code 99454 (device(s) supply with daily recordings or programmed alerts transmission each 30 day(s)), may not be reported for monitoring of less than 16 days. However, for purposes of treating suspected COVID-19 infections, Medicare will allow the service to be reported for shorter periods of time than 16 days as long as the other code requirements are met.

  • What about licensing and credentialing for telehealth services?

    Recommendations
    Answer

    CMS has issued a temporary waiver to allow physicians who are licensed in one state to provide services to a patient another state. This applies to Medicare and Medicaid, and certain conditions apply. Further, in order for the waiver to be effective, the state where the physician is performing the telehealth service must also waive its licensure requirements.

    CMS has not addressed the issue of credentialing with respect to telehealth and has pointed out that this is within the jurisdiction of the states to address.

    Resources

    A  CMS fact sheet updated 1/28/2021 on telehealth and other topics can be found at this link:  Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19

    The Interim Final Rules and waivers can be found at: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers

    CMS has released guidance to providers related to relaxed reporting requirements for quality reporting programs at https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf

    Answer

    CMS has issued a temporary waiver to allow physicians who are licensed in one state to provide services to a patient another state. This applies to Medicare and Medicaid, and certain conditions apply. Further, in order for the waiver to be effective, the state where the physician is performing the telehealth service must also waive its licensure requirements.

    CMS has not addressed the issue of credentialing with respect to telehealth and has pointed out that this is within the jurisdiction of the states to address.

    Resources

    A  CMS fact sheet updated 1/28/2021 on telehealth and other topics can be found at this link:  Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19

    The Interim Final Rules and waivers can be found at: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers

    CMS has released guidance to providers related to relaxed reporting requirements for quality reporting programs at https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf

Updated March 2021

Disclaimer

The American College of Emergency Physicians (ACEP) has developed the Reimbursement & Coding FAQs and Pearls for informational purposes only.   The FAQs and Pearls have been developed by sources knowledgeable in their fields, reviewed by a committee, and are intended to describe current coding practice. However, ACEP cannot guarantee that the information contained in the FAQs and Pearls is in every respect accurate, complete, or up to date.

The FAQs and Pearls are provided "as is" without warranty of any kind, either express or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Payment policies can vary from payer to payer. ACEP, its committee members, authors or editors assume no responsibility for, and expressly disclaim liability for, damages of any kind arising out of or relating to any use, non-use, interpretation of, or reliance on information contained or not contained in the FAQs and Pearls. In no event shall ACEP be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Specific coding or payment related issues should be directed to the payer.

For information about this FAQ/Pearl, or to provide feedback, please contact David A. McKenzie, ACEP Reimbursement Director at (469) 499-0133 or dmckenzie@acep.org.

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