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Telephone and Home Services In depth question

Meredith Posted Tue 04th of September, 2018 11:49:54 AM
Do any of the following payors accept 98966-98968 (telephone services), 99441-99443 (telephone consultations), 99446-99449 (interprofessional telephone/internet consultations), or 99341-99350 Home Services (provided in a residential home)?: (1) Aetna, (2) United HealthCare, (3) Cigna, (4) BCBS, (5) Medicare, (6) Tricare, (7) MO Medicaid, (8) KS Medicaid
SuperCoder Answered Wed 05th of September, 2018 04:07:36 AM

Hi Meredith,

 

Medicare would not pay CPT codes from the code range 98966-98968, 99441-99443 and 99446-99449 for telephone/telehealth and telemed services. There are more appropriate CPT codes provided by Medicare for the year 2018 known as telemetry codes for reimbursement purposes. These codes are 79 in number. We cannot provide you the complete list of codes here. SuperCoder website has a specific symbol assigned to Telemedicine codes.

 

Commercial payers are expected to abide by the rules set by Medicare. Commercial payers will reimburse 79 codes as directed by Medicare. For rest of the codes not paid by Medicare like CPT codes mentioned above, each commercial payer will have its specific rules, regulations and guidelines. You are requested to get in touch with the commercial payers for their specific guidelines, terms and conditions along with rules and regulations.

 

Home Health services are provided by Medicare. These codes are used to report evaluation and management services provided in a private residence. Commercial payer too pay for the services.

 

Medicaid reimbursement for telehealth varies from state to state. 48 states reimburse for Telehealth. Many of these states reimburse for the encounter + a separate CPT code (Q3014 - Originating site facility fee - $17 per session) to pay for technology costs + supervision on the client side. 

 

State Medicaid offices typically allow reimbursement for:

  • Office or outpatient visits (CPT codes 99203 - 99205, 99215)
  • Individual psychotherapy (CPT codes 90832 (30-minutes) 90834 (45 minutes) 90837 (60 minutes)
  • Psychiatric diagnostic interview examination (CPT code 90791 and 90792
  • Pharmacologic management (several Evaluation/Management codes such as 99213 for outpatient, 99212 for refills 99214 for complex situations

 

States may select from a variety of HCPCS codes (T1014 and Q3014), CPT codes and modifiers (GT, U1-UD) to identify, track and reimburse for telemedicine services.

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