Billing for telehealth
Learn about policies and reimbursement for telehealth services.
On this page:
Medicare
Many older adults are covered by Medicare fee-for-service. 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 and HCPCs codes | Description | Time | Audio-only coverage | Permanent coverage |
---|---|---|---|---|
98960 | Self-management, individual patient | 30 min | No | No |
98961 | Self-management, group (2-4 individuals) | 30 min | No | No |
98962 | Self-management, 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 |
G2112 | Prolonged outpatient visit | Additional 15 min | Yes | Yes |
Disease management
CPT and HCPCs codes | Description | Time | Audio-only coverage | Permanent coverage |
---|---|---|---|---|
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 |
96164 | Health behavior intervention, group | 30 min | Yes | Yes |
96165 | Health behavior intervention, group | Additional 15 min | Yes | Yes |
96167 | Health behavior intervention, patient with family | 30 min | Yes | Yes |
96168 | Health behavior intervention, patient with family | Additional 15 min | Yes | Yes |
96170 | Health behavior intervention, family without patient | 30 min | No | No |
96171 | Health behavior intervention, family without patient | Additional 15 min | No | No |
97802 | Medical nutrition therapy, initial assessment | 15 min | Yes | Yes |
97803 | Medical nutrition, reassessment | 15 min | Yes | Yes |
97804 | Medical nutrition, group assessment | 30 min | Yes | Yes |
99453 | Remote patient monitoring (RPM) device set up | N/A | N/A | No |
99454 | Monitoring data from RPM | N/A | N/A | No |
99457 | Patient-provider communication related to RPM data | 20 min | Yes | No |
99458 | Patient-provider communication related to RPM data | Additional 20 min | Yes | No |
G0270 | Medical nutrition therapy, reassessment, intervention | 15 min | Yes | Yes |
G0447 | Obesity counseling | 15 min | Yes | Yes |
Cardiovascular conditions
CPT and HCPCs codes | Description | Time | Audio-only coverage | Permanent coverage |
---|---|---|---|---|
93750 | Interrogation of ventricular assist device | N/A | No | No |
93797 | Cardiac rehabilitation, without ECG | 60 min | No | No |
93798 | Cardiac rehabilitation, with ECG | 60 min | No | No |
99473 | Self-measured blood pressure, education and training | N/A | No | No |
G0422 | Intensive cardiac rehabilitation, with exercise | 60 min | No | No |
G0423 | Intensive cardiac rehabilitation, without exercise | 60 min | No | No |
G0446 | Intensive behavioral therapy for cardiovascular disease | 15 min | Yes | Yes |
Pulmonary disease
CPT and HCPCs codes | Description | Time | Audio-only coverage | Permanent coverage |
---|---|---|---|---|
94005 | Home ventilator management supervision | N/A | No | No |
94625 | Pulmonary rehabilitation, without monitoring | 60 min | No | No |
94626 | Pulmonary rehabilitation, with monitoring | 60 min | No | No |
99664 | Demonstration or evaluation of use of inhaler | N/A | No | No |
Diabetes
CPT and HCPCs codes | Description | Time | Audio-only coverage | Permanent coverage |
---|---|---|---|---|
G0108 | Diabetes self-management training, individual | 30 min | Yes | Yes |
G0109 | Diabetes self-management training, group | 30 min | Yes | Yes |
Mental and behavioral health
CPT and HCPCs codes | Description | Time | Audio-only coverage | Permanent coverage |
---|---|---|---|---|
G0444 | Annual depression screening | 5-15 min | Yes | Yes |
90785 | Psychotherapy, with interactive complexity | N/A | Yes | Yes |
90791 | Psychological diagnostic evaluation | Up to 90 min | Yes | Yes |
90792 | Psychological diagnostic evaluation, with medical services | 1-2 hours | Yes | Yes |
90832 | Psychotherapy, no medical evaluation | 16-37 min | Yes | Yes |
90833 | Psychotherapy, with medical evaluation | 30 min | Yes | Yes |
90834 | Psychotherapy, no medical evaluation | 45 min | Yes | Yes |
90836 | Psychotherapy, with medical evaluation | 45 min | Yes | Yes |
90837 | Psychotherapy, no medical evaluation | Additional time | Yes | Yes |
90838 | Psychotherapy, with medical evaluation | Additional time | Yes | Yes |
90839 | Psychotherapy for crisis | 60 min | Yes | Yes |
90840 | Psychotherapy for crisis | Additional 30 min | Yes | Yes |
90845 | Psychoanalysis | N/A | Yes | Yes |
90846 | Family psychotherapy, without patient | 26 or more min | Yes | Yes |
90847 | Family psychotherapy, with patient | 26 or more min | Yes | Yes |
90853 | Group psychotherapy | 45-60 min | Yes | Yes |
Medicare Advantage
Many individuals have Medicare Advantage. Medicare Advantage plans may cover additional telehealth services or reduce cost-sharing. Check out the telehealth benefits for the Medicare Advantage plans in your area.
Dual eligible Medicare and Medicaid beneficiaries
Older adults who have dual eligibility to Medicare and Medicaid may have limited resources. Each state has its own billing and reimbursement policies. For tips on Medicaid policies, visit Medicaid and Medicare overview.
Private insurance
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 Policy Telehealth Resource Center