Heads up: this issue is from March 27, 2025. Because it covers time-sensitive coding and regulatory topics, some details may have changed since. See the latest issues for current guidance.
With the advent of new CPT codes for telehealth, which is basically a combo of E/M and audio-only codes in a more succinct format, there is coding confusion out there. First, Medicare renewed the telehealth waivers (until after September 30, 2025). That does not mean they have adopted all the NEW CPT codes. Here are the only coding changes that apply to Medicare:
- A brief check-in (an almost useless code, given the guidelines) is no longer G2012. It is now 98016.
- The audio-only codes have been deleted. Patients may only use audio services if they cannot or will not use real-time audio-visual technology. If this is the case, it must be documented in the medical record and billed as E/M with Modifier -93.
- Those are the only code changes Medicare has adopted in the Telehealth E/M for 2025. Otherwise, just stick to what you have been doing for 5 years. Do not use CPT codes, which may complicate secondary claims that do require the new codes.
For commercial payers, it is all over the show. Part B News has surveyed payers, and it looks like there are Blues that have adopted these codes. The best practice is to query your large payers and act accordingly.
When we thought we might not get telehealth extended past March, there was widespread panic (not the band, the emotions). However, please remember that if that day ever comes (which we really hope it doesn't), unless something changes, you will not be able to bill for E/M for a patient at home. But there are many non-face-to-face/remote services you CAN bill for, such as these Communication-based Technology Services (CTBS), which are not classified as telehealth because there is no face-to-face equivalent:
- Remote Physiological Monitoring (99453, 99454, 99497, 99498, 99091)
- Remote Therapeutic Monitoring (98975, 98976, 98977, 98978)
- Virtual Check-ins (G2010, 98016)
- Online E/M Services (99421, 99422, 99423, G2061, G2062, G2063)
- Internet/Interprofessional Consultations (99446, 99447, 99448, 99449, 99451, 99452)
- Chronic Care Management (99437, 99439, 99487, 99489, 99490, 99491)
- Chronic Pain Management (G3002, G3003)
- Transitional Care Management (99496, 99497)
- Principal Care Management (99424, 99425, 99426, 99427)
- Care Plan Oversight Services (G0181, G0182)
For a detailed description, please see this excellent article. Additionally, if Medicare goes back to the Dark Ages of telehealth, now you know all will not be lost.
