Learn about telemedicine codes that should be used in 2023.
Q: What are the new telemedicine service codes for 2023?
A: Medicare Telemedicine Services in 2023, The Centers for Medicare and Medicaid Services (CMS) will add new Healthcare Common Procedure Coding System (HCPCS) codes to the list of Medicare Telemedicine Services. Specifically, the following HCPCS code:
Extended service code
G0316: Long-term inpatient or observational care evaluation and management services that exceed the total hours of primary service (if primary service was selected using time of date of primary service); additional by a physician or qualified health care professional Every 15 minutes, with or without direct patient contact (list separately in addition to CPT code) 99223, 99233When 99236 for inpatient or observational care assessment and management services)
G0317: Prolonged care facility assessment and management services beyond the total hours of primary services (if primary services were selected using time of date of primary services); additional 15 minutes by physician or qualified health professional for each, with or without direct patient contact (list separately in addition to CPT code) 99306, 99310 for nursing home assessment and management services)
G0318: Home or dwelling assessment and management services extended beyond the total hours of primary service (if primary service was selected using hours of primary service date). Every additional 15 minutes by a physician or qualified health care professional, with or without direct patient contact (listed separately in addition to CPT code) 99345, 99350 for housing or dwelling valuation and management services)
For each of these codes, note the applicable service location (hospitalization/observation, nursing home, or home/residence). The original code for these services should have been selected based on time, not medical decision-making. These codes will not be billed for less than 15 minutes.
Chronic Pain Management and Treatment Bundle
G3002: A monthly bundle that includes chronic pain management and treatment, diagnostics.
- Administration of validated pain rating scales or tools;
- Developing, implementing, revising and/or maintaining an individual-centered care plan, including strengths, goals, clinical needs, and desired outcomes;
- overall treatment management;
- facilitation and coordination of necessary behavioral health treatments;
- medication administration;
- facilitation and coordination of necessary behavioral health treatments;
- Literacy counseling on pain and health.
- Required chronic pain-related crisis care. and/or
- Ongoing communication and coordination of care between relevant practitioners providing care, as appropriate (e.g. physical and occupational therapy, complementary and integrated approaches, community-based care).
An initial face-to-face visit of at least 30 minutes is required by a doctor or other qualified health care professional. Her first 30 minutes provided personally by a physician or other qualified health care professional each calendar month. (while using it G3002, should be greater than 30 minutes. )
G3003: Every calendar month, every additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional G3002). (Requires at least 15 minutes when using G3003)
The main points of CMS by Alliance to Advance Comprehensive Integrated Pain Management are:
- CMS specifically states:
- CMS requires an initial in-person visit to be able to claim the CPM code, but subsequent visits, whether monthly or otherwise, do not require in-person care.
- CMS requires billing providers to use validated pain scales, but does not require the use of a single pain rating scale. They don’t even give proper guidance on how to treat it. ”
Additional telemedicine codes to run through 2023
CMS holds many services temporarily available as telemedicine services during public health emergencies (PHEs) through 2023.
The status of over 40 codes on the Medicare Telemedicine Services list will change to “Available through December 31, 2023.” CMS will extend the period during which services are temporarily included on the Medicare Telemedicine Services List during PHE. CMS is implementing a 151-day extension of Medicare telemedicine flexibility in the 2022 Consolidated Budget Act (CAA). This includes enabling telemedicine services to be provided in any geographic region and in any original site setting, including the beneficiary’s home. We also allow certain services to be provided via voice-only communication systems and allow physical therapists, occupational therapists, speech pathologists, and audiologists to provide telemedicine services. The CAA will also postpone in-person visit requirements for mental health services delivered via telemedicine until 152 days after PHE ends.
Looking toward 2023, CMS will likely continue to charge telemedicine bills with service location indicators that show what would happen if services were billed for in-person visits. continues to be These claims must be qualified by Qualifier 95 to identify services performed and provided as telemedicine services until the end of 2023 or the end of PHE, whichever is later.
A list of codes to be added to the telemedicine services list can be found at https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.
Renee Dowling is a compliance auditor for Sansum Clinic, LLC in Santa Barbara, California.
