Telemedicine has proven to be an excellent care option for both patients and providers. Accurately coding for telemedicine services has become one of the biggest challenges faced in telehealth. This is largely due to the rapid succession of policy changes and the limited experience in properly documenting these services. And we are expecting some additional changes this year.
The following announcement appeared in today’s CMS weekly “MLNConnects” newsletter for January 16,2025:
Telehealth Flexibilities Extended until March 31
Recent legislation extended the waiver of the geographic, site of service, and practitioner type restrictions. Medicare patients in non-rural areas and in their homes can continue to get telehealth services from this extended range of practitioners until March 31, 2025.
Previously, any of the audio-video visits that a patient had with a provider were reported with the Evaluation and Management (E/M) codes for New (99202-99205) or Established (99211 – 99215) with a modifier -95 (synchronous telemedicine service rendered via a Real-Time Interactive Audio and Video Telecommunications Systems.
The AMA has added new codes for 2025 that will better show the resources that are used/needed to provide these services. CMS passed a rule that the payment will be cut and go back to the original rules before the Pandemic, however this is now extended until at least March 31, 2025.
These new codes must be performed on a separate calendar date than any other E/M service. If an E/M visit should occur, the time spent on the telemedicine service would be added to the E/M level.
Here are the new codes that are expected to go into effect:
Synchronous Audio-Video Evaluation and Management Services (98000- 98007)
- Both New (98000 – 98003) and Established patients (98004 – 98007)
- Real Time audio and video is required
- Service reported based on total time of the encounter or level of Medical Decision Making (MDM)
- Established patients must meet or exceed 10 minutes in order to use these codes
Synchronous Audio – Only Evaluation and Management Services (98008-98015)
- Both New (98008 – 98011) and Established patients (98012 – 98015)
- Real Time audio is required
- Service reported based on total time of the encounter or level of MDM
- Established patients must meet or exceed 10 minutes in order to use these codes
Brief Synchronous Communication Technology Service (Virtual Check-In) (98016)
- Reported for Established Patients only
- Patient initiated, intended to see if a more extensive visit is needed
- Video technology not required
- If an E/M is needed and time is used for the E/M, the time from this visit may be used in the overall level.
- Do NOT report if less than 5 minutes
When telemedicine is used effectively, it can significantly enhance healthcare access, convenience, and outcomes. As coding professionals, it’s essential to stay updated on any changes in telemedicine coding and reimbursement policies, especially this year. Count on LexiCode professionals to code these services correctly, or to keep your providers and coding team educated.
Denise Blackman, RHIA
LexiCode Director, Coding Compliance and Education