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For 2024, use modifier 95 when the clinician is in the hospital and the patient is in the home, and for outpatient therapy services provided via telehealth by qualified PTs, OTs, or SLPs. The telehealth originating site facility fee is 80 percent of the lesser of the actual charge, which is $29.96 for CY 2024 services. Source.
A: Established patient AWV codes G0438 and G0439 are both on the Medicare Telehealth Code List, so, yes, an AWV can be performed via telehealth. Note these codes generally cannot be billed more than once within 12 months. However, CMS is waiving limitations for many E/M codes during the PHE for COVID-19 pandemic.
The virtual check-in codes (G2010 and G2012), in contrast, are for brief audio-only or a picture-only encounters to determine the need for an office visit. Report these codes if the physician or other qualified healthcare professional has a medical discussion with the patient and gives treatment advice with no follow-up visit.
Every virtual visit gets a GT modifier, although some payers require something different, for us this gets flipped on the back end if need be. Video visits can be thought of as an office visit, billed with E&M. There is a blurb our providers put in like this -. This visit was performed via live interactive two-way video.
While the guidelines are shifting during this fluid situation, most commercial payers require that you report from the following code set for virtual check-in services: 99441 (Telephone evaluation and management service by a physician… 5-10 minutes of medical discussion) 99442 (…11-20 minutes of medical discussion) 99443 (…21-30 minutes ...
G2250 (Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward…) G2251 (Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services… 5-10 minutes of clinical discussion) These codes are ...
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