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Telehealth for older adults

Billing for telehealth

Learn about policies and reimbursement for telehealth services.

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 codesDescriptionTimeAudio-only coveragePermanent coverage
98960Self-management, individual patient30 minNoNo
98961Self-management, group (2-4 individuals)30 minNoNo
98962Self-management, group (5-8 individuals)30 minNo No
98966Telephone call for assessment and management by non-physician5-10 minYesYes
98967Telephone call for assessment and management by non-physician11-20 minYesYes
98968Telephone call for assessment and management by non-physician21-30 minYesYes
99202Outpatient visit, new patient15-29 minNoYes
99203Outpatient visit, new patient30-44 minNoYes
99204Outpatient visit, new patient45-59 minNoYes
99205Outpatient visit, new patient60-74 minNoYes
99211Outpatient visit, established patient5 minNoYes
99212Outpatient visit, established patient10-19 minNoYes
99213Outpatient visit, established patient20-29 minNoYes
99214Outpatient visit, established patient30-39 minNoYes
99215Outpatient visit, established patient40-55 minNoYes
99441Telephone call for evaluation and management5-10 minYesNo
99442Telephone call for evaluation and management11-20 minYesNo
99443Telephone call for evaluation and management21-30 minYesNo
G0438Initial annual wellness visitN/AYesYes
G0439Subsequent annual wellness visitN/AYesYes
G0506Comprehensive assessment care planN/AYesYes
G2112Prolonged outpatient visitAdditional 15 minYesYes

Disease management

CPT and HCPCs codesDescriptionTimeAudio-only coverage Permanent coverage
96156Health behavior assessmentN/AYesYes
96158Health behavior intervention30 minYesYes
96159Health behavior interventionAdditional 15 minYesYes
96160Patient-focused health risk assessment using standardized instrumentN/AYesYes
96164Health behavior intervention, group30 minYesYes
96165Health behavior intervention, groupAdditional 15 minYesYes
96167Health behavior intervention, patient with family30 minYesYes
96168Health behavior intervention, patient with familyAdditional 15 minYesYes
96170Health behavior intervention, family without patient30 minNoNo
96171Health behavior intervention, family without patientAdditional 15 minNoNo
97802Medical nutrition therapy, initial assessment15 minYesYes
97803Medical nutrition, reassessment15 minYesYes
97804Medical nutrition, group assessment30 minYesYes
99453Remote patient monitoring (RPM) device set upN/AN/ANo
99454Monitoring data from RPMN/AN/ANo
99457Patient-provider communication related to RPM data20 minYesNo
99458Patient-provider communication related to RPM dataAdditional 20 minYesNo
G0270Medical nutrition therapy, reassessment, intervention15 minYesYes
G0447Obesity counseling15 minYesYes

Cardiovascular conditions

CPT and HCPCs codesDescriptionTimeAudio-only coverage Permanent coverage
93750Interrogation of ventricular assist deviceN/ANoNo
93797Cardiac rehabilitation, without ECG60 minNoNo
93798Cardiac rehabilitation, with ECG60 minNoNo
99473Self-measured blood pressure, education and trainingN/ANoNo
G0422Intensive cardiac rehabilitation, with exercise60 minNoNo
G0423Intensive cardiac rehabilitation, without exercise60 minNoNo
G0446Intensive behavioral therapy for cardiovascular disease15 minYesYes

Pulmonary disease

CPT and HCPCs codesDescriptionTimeAudio-only coverage Permanent coverage
94005Home ventilator management supervisionN/ANoNo
94625Pulmonary rehabilitation, without monitoring60 minNoNo
94626Pulmonary rehabilitation, with monitoring60 minNoNo
99664Demonstration or evaluation of use of inhalerN/ANoNo

Diabetes

CPT and HCPCs codesDescriptionTimeAudio-only coveragePermanent coverage
G0108Diabetes self-management training, individual30 minYesYes
G0109Diabetes self-management training, group30 minYesYes

Mental and behavioral health

CPT and HCPCs codesDescriptionTimeAudio-only coverage Permanent coverage
G0444Annual depression screening5-15 minYesYes
90785Psychotherapy, with interactive complexityN/AYesYes
90791Psychological diagnostic evaluationUp to 90 minYesYes
90792Psychological diagnostic evaluation, with medical services1-2 hoursYesYes
90832Psychotherapy, no medical evaluation16-37 minYesYes
90833Psychotherapy, with medical evaluation30 minYesYes
90834Psychotherapy, no medical evaluation45 minYesYes
90836Psychotherapy, with medical evaluation45 minYesYes
90837Psychotherapy, no medical evaluationAdditional timeYesYes
90838Psychotherapy, with medical evaluationAdditional timeYesYes
90839Psychotherapy for crisis60 minYesYes
90840Psychotherapy for crisisAdditional 30 minYesYes
90845PsychoanalysisN/AYesYes
90846Family psychotherapy, without patient26 or more minYesYes
90847Family psychotherapy, with patient26 or more minYesYes
90853Group psychotherapy45-60 minYesYes

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