January 1, 2020
Telehealth/telemedicine services payment policy exceptions won’t be valid for claims processed April 5, 2020 and after.
These exceptions include:
- Telephone and online visits that occur within a period that is greater than 24 hours of a related office visit (same diagnosis code) being reimbursed.
- Telehealth visits (synchronous/asynchronous, telephone assessment and management and online internet communications) that occur on the same day or within 24 hours of a related Office Visit, only the Office Visit being reimbursed.
- Two telehealth visits (synchronous/asynchronous, telephone assessment and management or online internet communications) that occur on the same day will only be reimbursed when different providers perform the services, or the visits are for different diagnoses.
These exceptions conflict with the code descriptions for the telephone assessment and management codes and the online digital evaluation and management (E&M) Services codes listed in the CPT codebook and in the payment policy. Code descriptions that will now be enforced starting in April 2020 include but are not limited to the following:
- 99441 – Telephone E&M service by a physician or other qualified healthcare professional who may report E&M services provided to an established patient, parent or guardian not originating from a related E&M service provided within the previous 7 days nor leading to an E&M service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
- 99444 – Online E&M service provided by a physician or other qualified healthcare professional who may report an E&M service(s) provided to an established patient or guardian, not originating from a related E&M service provided within the previous 7 days, using the Internet or similar electronic communications network
The criteria in the code description will be enforced as of process dates April 5, 2020 and after. Make sure you and your staff are familiar with the recent Payment Policy updates for the Telehealth/Telemedicine Services Payment Policy.