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Expand Access and Capture Revenue: Five Medicare Telehealth Opportunities

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Telehealth has been available for decades, but its use as an effective, person-centered modality to deliver health care services has skyrocketed during the COVID-19 pandemic. In today’s climate, it’s commonly seen as a replacement for in-person visits to keep people safe, cut down on use of personal protective equipment (PPE), and prevent loss of access and revenue. While that is true, there are many additional ways to leverage telehealth.

Medicare telehealth services can be provided to both new and established patients with cost-sharing waived during the COVID-19 public health emergency (PHE). I encourage health care providers to consider telehealth opportunities in these five areas:


Transitional Care Management

In the Calendar Year 2020 Physician Fee Schedule Final Rule, the Centers for Medicaid & Medicare Services (CMS) responded to findings on the benefits and low usage of transitional care management services by increasing reimbursement and removing several co-billing restrictions, including allowing TCM services to be billed concurrently with chronic care management codes. CMS’ TCM services fact sheet is currently under revision, but little has changed from the January 2019 fact sheet.

During the public health emergency, TCM services delivered by telehealth are in the category that must be delivered using “an interactive audio and video telecommunications system that permits real-time communication between you at the distant site, and the beneficiary at the originating site.” TCM services cannot be delivered as audio-only. According to reports from the field, the visual part of the telehealth visit is helpful for several reasons, including allowing patients to show clinicians items and conditions in their home.


Medicare Codes for Transitional Care Management Services Reimbursement

Description Code Price
Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge; medical decision making of at least moderate complexity during the service period; face-to-face visit within 14 calendar days of discharge 99495 $187.67
Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge; medical decision making of at least high complexity during the service period; face-to-face visit within 7 calendar days of discharge 99496 $247.94

National payment amount for the non-facility price as of June 26, 2020, from the Medicare Physician Fee Schedule Look-Up Tool. During the PHE, the Medicare reimbursement for all telehealth services for Rural Health Clinics and Federally Qualified Health Centers is $92.03. I am not a billing professional; please check with your biller or coder for further guidance.


Advance Care Planning

Now more than ever, advance care planning is a critical component of health care service delivery. Nursing facilities, primary care practices and specialty practices should be offering ACP to all patients. Some individuals may prefer to modify their preferences for hospitalizations and care decisions should they contract COVID-19. Whether or not to use ventilator therapy is a key consideration, especially for those who have previously stated they would like to be do-not-resuscitate or do-not-intubate (DNR/DNI). Although completing advance directives is a best practice, it is not required to provide and bill for ACP.

For more about ACP, see CMS’ Advance Care Planning Fact Sheet or contact Comagine Health to request our Advance Care Planning Toolkit.


Medicare Codes for Advance Care Planning Reimbursement

Description Code Price
Advance care planning, including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s) and/or surrogate 99497 $86.98
Advance care planning, including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes. List separately in addition to code for primary procedure. 99498 $76.15

National payment amount for the non-facility price as of June 26, 2020, from the Medicare Physician Fee Schedule Look-Up Tool. During the PHE, the Medicare reimbursement for all telehealth services for Rural Health Clinics and Federally Qualified Health Centers is $92.03. I am not a billing professional; please check with your biller or coder for further guidance.


Diabetes Self-Management Training and Medical Nutrition Therapy

Diabetes self-management training and medical nutrition therapy are limited to specific populations: those with diabetes and/or those with kidney disease. However, DSMT and MNT are key to optimizing care and fostering self-efficacy through self-management knowledge and skills.

DSMT and MNT are grossly underutilized at 5-7% for a variety of reasons. For the duration of the PHE they can be delivered by telehealth as audio-only. Additionally, providing these services comports with evidence-based guidelines. The American Diabetes Association’s 2020 Standards of Medical Care in Diabetes states that “all people with diabetes should participate in diabetes self-management education” and “all individuals with diabetes should be referred for individualized MNT.”

Even if you don’t have staff credentialed to deliver these services, you can refer appropriately to ensure everyone who has this benefit receives it. Medicare DSMT and MNT benefits are for diabetes (type 1 or 2) or kidney disease (non-dialysis or post-transplant) and include:

  • Initial — 10 hours of DSMT and 3 hours of MNT within a continuous 12 months
  • Follow-up — 2 hours each of DSMT and MNT per calendar year

The Centers for Disease Control and Prevention’s (CDC) Medicare Reimbursement Guidelines for DSMT is a good place to start learning about DSMT.


Medicare Codes for Diabetes Self-Management Training and Medical Nutrition Therapy

Description Code Price
Diabetes outpatient self-management training services, individual, per 30 minutes G0108 $57.02
Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes G0109 $15.88
Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes 97802 $38.25
Medical nutrition therapy; reassessment and intervention, individual, face-to-face with the patient, each 15 minutes 97803 $33.20
Medical nutrition therapy; group (2 or more individuals), each 30 minutes 97804 $17.32
Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face-to-face with the patient, each 15 minutes G0270 $33.20

National payment amount for the non-facility price as of June 26, 2020, from the Medicare Physician Fee Schedule Look-Up Tool. During the PHE, the Medicare reimbursement for all telehealth services for Rural Health Clinics and Federally Qualified Health Centers is $92.03. I am not a billing professional; please check with your biller or coder for further guidance.


Annual Wellness Visits

Many practices already provide in-person initial preventive physical examinations (IPPE) and annual wellness visits for their Medicare patients, but these can also be conducted through telehealth. Now may a good time to conduct proactive outreach to those due for an IPPE or AWV. See CMS’ Annual Wellness Visit Booklet for help complying with the requirements for these visits as well as Comagine Health’s Annual Wellness Visit Implementation Guide.


Medicare Codes for Annual Wellness Visits

Description Code Price
Annual wellness visit, includes a personalized prevention plan of service (PPPS), initial visit G0438 $172.87
Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit G0439 $117.29

National payment amount for the non-facility price as of June 26, 2020, from the Medicare Physician Fee Schedule Look-Up Tool. During the PHE, the Medicare reimbursement for all telehealth services for Rural Health Clinics and Federally Qualified Health Centers is $92.03. I am not a billing professional; please check with your biller or coder for further guidance.


Lifestyle Changes and Screening

We know that individuals with diabetes, hypertension and obesity are at higher risk for death and poor outcomes from COVID-19. Behavioral health concerns like depression and anxiety are also more frequent. Telehealth visits can allow you to safely administer these assessments and provide counseling. There are additional lifestyle, screening and related telehealth opportunities. For example, faced with potential severe respiratory effects of COVID-19, tobacco users may be ready to quit. Note that even though some code descriptions include “face-to-face,” these services can be delivered by telehealth.


Medicare Codes for Lifestyle Changes and Screening

Description Code Price

Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

See Coding Reference: Tobacco Use Prevention and Cessation Counseling

99406 $15.52
Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes. 99407 is not an add-on code; the two codes are never reported together. 99407 $29.59

Counseling visit to discuss need for lung cancer screening using low dose CT scan (LDCT) (service is for eligibility determination and shared decision making)

See Medicare Coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT). For a decision tree and lung cancer screening guidelines across organizations, see Lung Cancer Screening Guidelines Implementation in Primary Care: A Call to Action.

G0296 $29.95

Alcohol and/or substance (other than tobacco) abuse structured assessment (for example, AUDIT, DAST) and brief intervention, 15 to 30 minutes

See Summary of Medicare Reporting and Payment of Services for Alcohol and/or Substance (Other Than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT) Services

G0396 $36.81

Alcohol and/or substance (other than tobacco) abuse structured assessment (for example, AUDIT, DAST) and intervention, greater than 30 minutes

See Summary of Medicare Reporting and Payment of Services for Alcohol and/or Substance (Other Than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT) Services

G0397 $68.93

Annual alcohol misuse screening, 15 minutes

See Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse

G0442 $18.41
Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes G0443 $26.71

Annual depression screening, 15 minutes

See Screening for Depression in Adults

G0444 $18.41
Annual, face-to-face intensive behavioral counseling (IBT) for cardiovascular disease (CVD), individual, 15 minutes G0446 $26.71
Face-to-face behavioral counseling for obesity, 15 minutes G0447 $26.71

High-intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training, and guidance on how to change sexual behavior; performed semi-annually, 30 minutes

See Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs

G0445 $28.15

National payment amount for the non-facility price as of June 26, 2020, from the Medicare Physician Fee Schedule Look-Up Tool. During the PHE, the Medicare reimbursement for all telehealth services for Rural Health Clinics and Federally Qualified Health Centers is $92.03. I am not a billing professional; please check with your biller or coder for further guidance.


These telehealth opportunities can help health care organizations achieve the quadruple aim — lowered per beneficiary cost, improved health outcomes, enhanced patient experience and improved staff work life — any time, but this is especially true during the coronavirus pandemic.

Please email me at tbearden@comagine.org for assistance or for a copy of any of the resources referenced in this article.


Learn More

Want more information about enhancing your practice's telehealth offerings? Visit our Telemedicine and Virtual Services page, where we've compiled select up-to-date resources.

Need help responding to the coronavirus pandemic? Our COVID-19-related services include telehealth, infection prevention, data analytics and contact tracing.

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