American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Medicare Coverage for Virtual Services

What are the differences between virtual services?

Telehealth E/M Telephone E/M E-Visit Virtual Check-In Remote Image Evaluation
Modalities Audio and video (see list of telehealth vendors) Telephone (audio only) Online patient portal Phone, secure email or text message, patient portal Store and forward asynchronous technology
Service description Interactive E/M service via real-time, two-way video call Patient-initiated E/M service via real-time telephone call Patient-initiated E/M service via online patient portal Brief assessment to determine whether an in-person office visit or other service is required Evaluation and interpretation of a pre-recorded video or image provided by a patient
Eligible providers Physician, physician assistant, nurse practitioner Physician, physician assistant, nurse practitioner, other qualified nonphysician provider Physician, physician assistant, nurse practitioner, other qualified nonphysician provider Physician, physician assistant, nurse practitioner Physician, physician assistant, nurse practitioner
Patient relationship New and established patients New and established patients (new patients allowed during PHE) New and established patients (new patients allowed during PHE) New and established patients (new patients allowed during PHE) New and established patients (new patients allowed during PHE)
Codes CPT codes 99201-99205
(new patients)

CPT codes 99211-99215
(established patients)
CPT codes 99441-99443
(for MDs/DOs, PAs, NPs)

CPT codes 98966-98968
(for other qualified NPPs)
CPT codes 99421-99423
(for MDs/DOs, PAs, NPs)

HCPCS codes G2061-G2063
(for other qualified NPPs)
HCPCS code G2012 HCPCS code G2010
Telehealth Modifier 95 (telemedicine)

CS (E/M service related to COVID-19 testing)*
N/A N/A N/A N/A

*Physicians should append both modifiers 95 and CS on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services to get 100% of the Medicare-approved amount. Modifier CS may be used for services furnished on March 18, 2020, and through the end of the PHE.

Virtual Service Codes

Telehealth Office/Outpatient Evaluation and Management Visits

Synchronous audio AND visual evaluation and management visit between a patient and clinician

CPT Code Description Time* Medical
Decision-Making
99201 Office or other outpatient visit for the evaluation and management of a new patient N/A Straightforward
99202 15–29 minutes Straightforward
99203 30–44 minutes Low complexity
99204 45–59 minutes Moderate complexity
99205 60–74 minutes High complexity
99211 Office or other outpatient visit for the evaluation and management of an established patient N/A N/A
99212 10–19 minutes Straightforward
99213 20–29 minutes Low complexity
99214 30–39 minutes Moderate complexity
99215 40–54 minutes High complexity

*NOTE: During the PHE, telehealth E/M code selection can be based on medical decision-making or time alone. When selecting a code based on time, use total time of the physician and/or qualified health care professional on the date of the encounter.

Information about other telehealth services covered by Medicare during the PHE can be found at the following link:

List of Covered Medicare Telehealth Services (During COVID-19 PHE)

Telephone Evaluation and Management Services

Evaluation and management visits via audio-only telephone communications

CPT Code

Description

 

Physician/QHP Services*

99441

Telephone evaluation and management service by a physician or other qualified health care professional (QHP) who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5–10 minutes of medical discussion

99442

11-20 minutes of medical discussion

99443

21-30 minutes of medical discussion

 

Qualified Nonphysician Health Care Professional Services

98966

Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment

98967

11-20 minutes of medical discussion

98968

21-30 minutes of medical discussion

*NOTE: During the PHE, payment rates for audio-only telephone E/M codes 99441-99443 will be increased to match those of established patient office/outpatient E/M codes 99212-99214.

E-Visits

Communication between a patient and a physician or qualified nonphysician practitioner through an online patient portal or secure email

CPT/HCPCS Code

Description

99421

Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

99422

11-20 minutes

99423

21 or more minutes

98970

Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

98971

11-20 minutes

98972

21 or more minutes

G2061

Qualified nonphysician health care professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes

G2062

11-20 minutes

G2063

21 or more minutes

Virtual Check-Ins

Brief check-in via telecommunications technology to decide whether an office visit or other service is needed

HCPCS Code

Description

G2012

Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

Remote Image Evaluation

Remote review of video and/or images submitted by a patient, with interpretation and report

HCPCS Code

Description

G2010

Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment