Billing for HIV care via telehealth
Learn about policies and reimbursement for telehealth services.
On this page:
Medicare
Medicare policies for telehealth continue to evolve. For the latest information, view the list of telehealth services. The following Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes are frequently used to bill for telehealth services. Coding guidance is subject to change.
Primary care
| CPT/HCPCs code | Description | Time | Audio-only coverage | Permanent coverage for telehealth |
|---|---|---|---|---|
| 98960 | Self-management, individual patient | 30 min | No | No |
| 98961 | Self-management training, group (2-4 individuals) | 30 min | No | No |
| 98962 | Self-management training, group (5-8 individuals) | 30 min | No | No |
| 98966 | Telephone call for assessment and management by non-physician | 5-10 min | Yes | Yes |
| 98967 | Telephone call for assessment and management by non-physician | 11-20 min | Yes | Yes |
| 98968 | Telephone call for assessment and management by non-physician | 21-30 min | Yes | Yes |
| 99202 | Outpatient visit (new patient) | 15-29 min | No | Yes |
| 99203 | Outpatient visit (new patient) | 30-44 min | No | Yes |
| 99204 | Outpatient visit (new patient) | 45-59 min | No | Yes |
| 99205 | Outpatient visit (new patient) | 60-74 min | No | Yes |
| 99211 | Outpatient visit (established patient) | 5 min | No | Yes |
| 99212 | Outpatient visit (established patient) | 10-19 min | No | Yes |
| 99213 | Outpatient visit (established patient) | 20-29 min | No | Yes |
| 99214 | Outpatient visit (established patient) | 30-39 min | No | Yes |
| 99215 | Outpatient visit (established patient) | 40-55 min | No | Yes |
| 99441 | Telephone call for evaluation and management | 5-10 min | Yes | No |
| 99442 | Telephone call for evaluation and management | 11-20 min | Yes | No |
| 99443 | Telephone call for evaluation and management | 21-30 min | Yes | No |
| G0438 | Initial annual wellness visit | N/A | Yes | Yes |
| G0439 | Subsequent annual wellness visit | N/A | Yes | Yes |
| G0506 | Comprehensive assessment care plan | N/A | Yes | Yes |
| G2212 | Prolonged outpatient visit | Additional 15 min | Yes | Yes |
Disease management
| CPT/HCPCs code | Description | Time | Audio-only coverage | Permanent coverage for telehealth |
|---|---|---|---|---|
| 96156 | Health behavior assessment | N/A | Yes | Yes |
| 96158 | Health behavior intervention | 30 min | Yes | Yes |
| 96159 | Health behavior intervention | Additional 15 min | Yes | Yes |
| 96160 | Patient-focused health risk assessment using standardized instrument | N/A | Yes | Yes |
Medicaid
Each state has its own billing and reimbursement policies. For tips on Medicaid policies, visit Medicaid and Medicare overview.
Private insurance
Find out if the patient has private insurance. If so, check with the patient's insurance company for information on their billing and reimbursement policies. For tips on private insurance policies, look up policy by jurisdiction.
More information:
Billing for Providers- What should I know? (PDF)— Health Resources and Services Administration
Billing for telehealth — Health Resources and Services Administration
Medicare and Medicaid policies — Health Resources and Services Administration
Medicare payment policies — Health Resources and Services Administration
Telehealth policy — Health Resources and Services Administration
Understanding telehealth policy — National Telehealth Policy Resource Center