Billing and payment policies for telehealth services to treat chronic conditions
Many billing codes and payment policies for chronic condition treatment and management are the same whether used for telehealth or in-person services. There are, however, some codes specific to telehealth.
As you prepare to launch your telehealth care program, take time to fully understand your billing options. You may need to consider extra staffing or additional training so your office is ready to seamlessly handle telehealth billing.
Many private insurers are also covering telehealth appointments, with patients paying their typical co-pay. You can also choose to offer a discounted cash pay program or private payment options for the underinsured or the uninsured.
One possible way to offer discounted payment is to find stakeholders willing to partner with you. You could also explore local, state, and federal grant funding options.
Quick resources
Get more information on billing for direct-to-consumer telehealth.
Read more about billing and reimbursement for telehealth during the COVID-19 public health emergency.
Medicare billing guidance
The following common Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes are used to bill for services for telemedicine for chronic conditions.
Coding guidance is subject to change. Please refer to the complete list of telehealth services covered by Medicare during the COVID-19 public health emergency from the Centers for Medicare & Medicaid Services.
Audio-only or video telehealth
Category | Telehealth CPT codes and HCPCS codes |
---|---|
Telephone evaluation and management service |
99441, 99442, 99443, G0438, G0439 |
Screening, brief intervention, and referral to treatment |
G0396, G0397, G0442, G0443, G0444, G0445, G0446, G0447 |
Evaluation and monitoring outpatient follow-up |
99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215 |
Observation care discharge |
99217* |
Initial observation care |
99218, 99219, 99220** |
Subsequent observational care |
99224, 99225, 99226 |
Opioid use disorder treatment |
G2086, G2087, G2088 |
Alcohol and substance abuse assessment |
G0396, G0397 |
Diabetes Care Management: Phone evaluation and management |
99441, 99442, 99443 |
Diabetes self-management training |
G0108, G0109 |
Medical nutrition therapy |
97802, 97803, 97804, G0270 |
Psychotherapy |
90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838 |
Renal Care: Phone evaluation and management |
99441, 99442, 99443 |
Renal Care: Outpatient dialysis services |
90951, 90952, 90953, 90954, 90955, 90956, 90957 ,90958, 90959, 90960, 90961, 90962 |
Renal Care: Hospital care services, with the limitation of 1 telehealth visit every 3 days |
99231, 99232, 99233 |
Renal Care: Individual and group kidney disease education |
G0420, G0421 |
Renal Care: Transitional care management services |
99495, 99496 |
Renal Care: Advance care planning |
99497, 99498 |
Renal Care: Prolonged service |
99354, 99355, 99356, 99357 |
Renal Care: Telehealth consultations, critical care |
G0508, G0509 |
Pulmonary Care: Phone evaluation and management |
99441, 99442, 99443 |
Pulmonary Care: Rehabilitation |
94625, 94626, G0424 |
Pulmonary Care: Transitional care management services |
99495, 99496 |
Pulmonary Care: Advance care planning |
99497, 99498 |
Pulmonary Care: Prolonged service |
99354, 99355, 99356, 99357 |
Pulmonary Care: Ventilator management |
94002, 94003, 94004, 94005 |
Pulmonary Care: Evaluate patient use of inhaler |
94664 |
Cardiac Care: Phone evaluation and management |
99441, 99442, 99443 |
Cardiac Care: Transitional care management services |
99495, 99496 |
Cardiac Care: Advance care planning |
99497, 99498 |
Cardiac Care: Prolonged service |
99354, 99355, 99356, 99357 |
Cardiac Care: Cardiac rehab |
93797, 93798, G0422, G0423 |
Cardiac Care: In-person ventricular assist device interrogation |
93750 |
Stroke and Rehabilitation Care: Phone evaluation and management |
99441, 99442, 99443 |
Physical Therapy Services |
97161, 97162, 97163, 97164, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, 97761; G2061, G2062, G2063 |
Occupation Therapy Services |
97165, 97166, 97167, 97168 |
Speech Therapy |
92507, 92508, 92521, 92522, 92523, 92524, 92526 |
Aphasia Assessment |
96105 |
Cancer Care: Phone evaluation and management |
99441, 99442, 99443 |
Cancer care: Radiation oncology treatment management |
77427 |
Dementia Care: Phone evaluation and management |
99441, 99442, 99443, G0438, G0439 |
Dementia Care: Cognitive assessment and care plan services |
99483 |
* Remains available until December 31, 2023
** Will expire at some point after the COVID-19 public health emergency is declared over
More resources
Medicare Coverage and Payment of Virtual Services (video) — from the Centers for Medicare & Medicaid Services
Current State Laws & Reimbursement Policies — from the National Policy Center - Center for Connected Health Policy