A Comprehensive Guide to Telehealth Billing 2023

COVID-19 has brought multiple changes into our daily lives; one of those changes is a growing number of people opting for telehealth. Compared to 2019, when only 10% of people actively acquired telehealth services, a recent survey shows that approximately 52% of adults use telemedicine.

Post-pandemic, there was a surge in demand for telehealth services because many patients deem it a more convenient option than in-person visits. Now, approximately 76% of healthcare organizations in the U.S. allow patients to consult with providers virtually. 

Telemedicine is significantly different today from what it was pre-pandemic. Even the recent legislation by the U.S. Department of Health and Human Services authorized multiple changes, some of which are permanent.
In this guide, we’ll help you navigate medicare telehealth billing guidelines 2023, including updated telehealth CPT codes, telemedicine modifiers, and reimbursement for telehealth.

Telemedicine is significantly different today from what it was pre-pandemic. Even the recent legislation by the U.S. Department of Health and Human Services authorized multiple changes, some of which are permanent.
In this guide, we’ll help you navigate medicare telehealth billing guidelines 2023, including updated telehealth CPT codes, telemedicine modifiers, and reimbursement for telehealth.

What Is Telehealth? 

Telehealth, also known as telemedicine, is a term used to describe the use of telecommunication and electronic information to address health needs. Common technologies to extend care include streaming media, wireless communications, and video conferencing. Telemedicine billing services can vary depending on your geographic location and the insurance provider or payer you are billing.

Benefits of Using Telehealth

One main reason people were using telehealth during COVID-19 is because it eliminated the travel burden for patients who were vulnerable to the virus. Other than that, telehealth provides multiple benefits, including,

1. Vital details of a patient’s health can reach their assigned caretakers and healthcare team in time with the help of health monitoring services. 
2. People struggling with poor mental health can seek online therapy services. 
3. You can partner with telepharmacy services to deliver prescriptions to your patient’s doorstep. 
4. With telehealth, uninsured patients are billed by providers at a price similar to a normal insurance copay, expanding their access to healthcare services. 

Getting Reimbursed for Telehealth

One common query most providers have is how they will get reimbursement for telehealth. The answer is that reimbursement rates for telehealth can vary due to laws such as the Pay Parity Laws and whether the qualified healthcare professional is receiving reimbursement from a private payer, Medicaid plan, or Medicare.
For instance, if you live in one of the states that follow the pay parity laws, you will get reimbursement for telehealth similar to the reimbursement you get for in-person visits for the respective service.

Telehealth Billing Guidelines 2023

Telehealth Modifier 93 

Generally, all telehealth sessions, except audio-only sessions, are billed using the modifier 95 or the GT modifier, varying depending on the payer billed for the services. Modifier 95 description includes the CPT code modifier used to bill telehealth services with the place of service code 11, which indicates an office. The place of service code 11 is the same code used when services are rendered in person. 

Modifier 93 is a new CPT code modifier that came into effect at the start of 2022. This modifier describes a real-time interaction between a patient and a qualified healthcare professional located at different sites. It is essential for healthcare providers to bill all audio-only telehealth services using this modifier. 

Temporary Changes In Medicare Telehealth 2023

The changes made in the COVID-19 Public Health Emergency (PHE) were initially meant to be temporary, but the bill passed at the end of last year caused these temporary changes in telehealth billing guidelines to be extended through December 31, 2024.

Two temporary changes that ended back in May included telehealth being provided as an exceptional benefit and Medicare-covered providers not being subject to a federal penalty for using applications that aren’t HIPAA-complaint to communicate with their patients.

The changes that will extended through December 2024 are:

1. Mental health and non-behavioral services can be obtained at any site. Originating site geographic restrictions for these services are waived.
2. Some mental health and non-behavioral services can be delivered through audio-only communication.
3. In-person visits within the first six months of initial non-behavioral and mental health service are also not required. The effective date of this rule was postponed for 151 days after the PHE, which ended in May.
4. Occupational therapists, pathologists, audiologists, and physical therapists are now considered practitioners who can provide care using telehealth.

Permanent Medicare Telehealth Changes 

The focus of the majority of permanent changes made by the CMS (Centers for Medicare and Medicaid) is on mental health care. These include: 

1. RHCs (Rural Health Clinics) and FQHCs (Federally Qualified Healthcare Centers) can be distant site providers for non-behavioral and mental health services. 
2. One of the eligible originating sites for telemedicine services is REH (Rural Emergency Hospital). 
3. Practitioners will no longer receive separate reimbursement for audio-only E/M services. 
4. Virtual Direct Supervision is set to continue only until the end of 2023 and will not remain a permanent feature of Medicare. 
5. Although CMS suggested five new codes to be added permanently to the Medicare Telehealth Services list, only three codes for chronic pain management and prolonged E/M services are made permanent as they are sufficiently similar to other services listed currently on a Category 1 basis. 

FAQs 

How to bill for telemedicine?

To bill for telemedicine, you must first determine the usage and type of telemedicine you offer, check any reimbursement and compliance policies appertaining to your claim, perform accurate coding using modifier 95 or GT depending on the payer, and finally add any CPT codes applicable to the telehealth services rendered. 

Is telehealth covered by insurance in 2023?

Other than Medicare and Medicaid, telemedicine services are covered by most private health insurance plans. However, depending on the state you belong to and the insurance carrier’s policies, reimbursement rates and telehealth coverage may vary. Telehealth services can be rendered through online consultations, audio, or video, so it is best to check in with the payer on what they cover and get a clear idea of the billing requirements. 

Does Medicare cover telehealth?

Typically, telehealth services are covered under Medicare Part B, which has a deductible of $226 in 2023. So, after a patient meets the part B deductible, they only pay 20% of the total Medicare-approved amount to their assigned physician or healthcare provider for the services rendered.