Code Service Description

Telemedicine Reimbursement

Policy Position for Commercial

90785 Interactive complexity (add-on code) Existing

90791 Psychiatric diagnostic evaluation Existing

90792 Psychiatric diagnostic evaluation with medical services Existing

90832 Psychotherapy, 30 minutes with patient Existing

90833 Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (add-on code)

Existing

90834 Psychotherapy, 45 minutes with patient Existing

90836 Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (add-on code)

Existing

90837 Psychotherapy, 60 minutes with patient Existing

90838 Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (add-on code)

Existing

90839 Psychotherapy for crisis; first 60 minutes Existing

90840 Psychotherapy for crisis; each additional 30 minutes (add-on code) Existing

90845 Psychoanalysis Existing

90846 Family psychotherapy (without the patient present), 50 minutes Existing

90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes Existing

90863 Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (add-on code)

Existing

90951 Dialysis services (4 or more physician visits per month), patient younger than 2 years of age Existing

90952 Dialysis services (2-3 physician visits per month), patient younger than 2 years of age Existing

90953 Dialysis services (1 physician visit per month), patient younger than 2 years of age Existing

90954 Dialysis services (4 or more physician visits per month), patient 2-11 years of age Existing

90955 Dialysis services (2-3 physician visits per month), patient 2-11 years of age Existing

90956 Dialysis services (1 physician visit per month), patient 2-11 years of age Existing

90957 Dialysis services (4 or more physician visits per month), patient 12-19 years of age Existing

90958 Dialysis services (2-3 physician visits per month), patient 12-19 years of age Existing

90959 Dialysis services (1 physician visit per month), patient 12-19 years of age Existing

90960 Dialysis services (4 or more physician visits per month), patient 20 years of age and older Existing

90961 Dialysis services (2-3 physician visits per month), patient 20 years of age and older Existing

90963 Home dialysis services per month, patient younger than 2 years of age Existing

90964 Home dialysis services per month, patient 2-11 years of age Existing

90965 Home dialysis services per month, patient 12-19 years of age Existing

90966 Home dialysis services per month, patient 20 years of age or older Existing

90967 Dialysis services, per day (less than full month service), patient younger than 2 years of age Existing

90968 Dialysis services, per day (less than full month service), patient 2-11 years of age Existing

90969 Dialysis services, per day (less than full month service), patient 12-19 years of age Existing

90970 Dialysis services, per day (less than full month service), patient 20 years of age or older Existing

92507 Treatment Of Speech, Language, Voice, Communication, And/or Auditory Processing Disorder

Extended

Commercial & ASO Existing and Extended Telemedicine Policy Codes

1.

Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from Federal and State agencies.

92520 Laryngeal function studies (ie, aerodynamic testing and acoustic testing) Extended

92521 Evaluation of speech fluency (eg, stuttering, cluttering) Extended

92522 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria);

Extended

92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)

Extended

92524 Behavioral and qualitative analysis of voice and resonance Extended

92526 Treatment of swallowing dysfunction and/or oral function for feeding Extended

92592 Hearing aid check; monaural Extended

92593 Hearing aid check; binaural Extended

92610 Evaluation of oral and pharyngeal swallowing function Extended

92625 Assessment of tinnitus (includes pitch, loudness matching, and masking) Extended

96105 Assessment of expressive and receptive speech with interpretation and report per hour Extended

96116 Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes

Existing

96156 Health behavior assessment, or re-assessment Extended

96158 Health behavior intervention, individual, face-to-face; initial 30 minutes Extended

96159 Health behavior intervention, individual, face-to-face; each additional 15 minutes (add-on code)

Extended

96160 Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument

Existing

96161 Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument

Existing

97110 Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

Extended

97129 Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity, direct (one-on-one) patient contact; initial 15 minutes

Extended

97130 Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity, direct (one-on-one) patient contact; each additional 15 minutes (add-on code)

Extended

97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s)

Extended

97152 Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes

Extended

97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes

Extended

97154 Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes

Extended

97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes

Extended

2.

Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from Federal and State agencies.

Commercial & ASO Existing and Extended Telemedicine Policy Codes

97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes

Extended

97157 Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes

Extended

97158 Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes

Extended

97161 Evaluation of physical therapy, typically 20 minutes Extended

97162 Evaluation of physical therapy, typically 30 minutes Extended

97163 Evaluation of physical therapy, typically 45 minutes Extended

97164 Re-evaluation of physical therapy, typically 20 minutes Extended

97165 Evaluation of occupational therapy, typically 30 minutes Extended

97166 Evaluation of occupational therapy, typically 45 minutes Extended

97167 Evaluation of occupational therapy established plan of care, typically 60 minutes Extended

97168 Re-evaluation of occupational therapy established plan of care, typically 30 minutes Extended

97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes

Extended

97535 Self-care/home management training and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes

Extended

97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes

Existing

97803 Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes

Existing

97804 Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes Existing

98960 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient

Extended

98961 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 2-4 patients

Extended

98962 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5-8 patients

Extended

98966 Telephone assessment and management service, 5-10 minutes of medical discussion Extended

98967 Telephone assessment and management service, 11-20 minutes of medical discussion Extended

98968 Telephone assessment and management service, 21-30 minutes of medical discussion Extended

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

Extended

98971 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; 11-20 minutes

Extended

98972 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; 21 or more minutes

Extended

3.

Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from Federal and State agencies.

Commercial & ASO Existing and Extended Telemedicine Policy Codes

99201 New patient office or other outpatient visit, typically 10 minutes Existing

99202 New patient office or other outpatient visit, typically 20 minutes Existing

99203 New patient office or other outpatient visit, typically 30 minutes Existing

99204 New patient office or other outpatient visit, typically 45 minutes Existing

99205 New patient office or other outpatient visit, typically 60 minutes Existing

99211 Established patient office or other outpatient visit, typically 5 minutes Existing

99212 Established patient office or other outpatient visit, typically 10 minutes Existing

99213 Established patient office or other outpatient visit, typically 15 minutes Existing

99214 Established patient office or other outpatient, visit typically 25 minutes Existing

99215 Established patient office or other outpatient, visit typically 40 minutes Existing

99231 Subsequent hospital inpatient care, typically 15 minutes per day Existing

99232 Subsequent hospital inpatient care, typically 25 minutes per day Existing

99233 Subsequent hospital inpatient care, typically 35 minutes per day Existing

99241 Patient office consultation, typically 15 minutes Existing

99242 Patient office consultation, typically 30 minutes Existing

99243 Patient office consultation, typically 40 minutes Existing

99244 Patient office consultation, typically 60 minutes Existing

99245 Patient office consultation, typically 80 minutes Existing

99251 Inpatient hospital consultation, typically 20 minutes Existing

99252 Inpatient hospital consultation, typically 40 minutes Existing

99253 Inpatient hospital consultation, typically 55 minutes Existing

99254 Inpatient hospital consultation, typically 80 minutes Existing

99255 Inpatient hospital consultation, typically 110 minutes Existing

99307 Subsequent nursing facility visit, typically 10 minutes per day Existing

99308 Subsequent nursing facility visit, typically 15 minutes per day Existing

99309 Subsequent nursing facility visit, typically 25 minutes per day Existing

99310 Subsequent nursing facility visit, typically 35 minutes per day Existing

99354 Prolonged office or other outpatient service first hour Existing

99355 Prolonged office or other outpatient service each 30 minutes beyond first hour Existing

99356 Prolonged inpatient or observation hospital service first hour Existing

99357 Prolonged inpatient or observation hospital service each 30 minutes beyond first hour Existing

99381 Initial new patient preventive medicine evaluation infant younger than 1 year Extended

99382 Initial new patient preventive medicine evaluation, age 1 through 4 years Extended

99383 Initial new patient preventive medicine evaluation, age 5 through 11 years Extended

99384 Initial new patient preventive medicine evaluation, age 12 through 17 years Extended

99385 Initial new patient preventive medicine evaluation age 18-39 years Extended

99386 Initial new patient preventive medicine evaluation age 40-64 years Extended

99387 Initial new patient preventive medicine evaluation, age 65 years and older Extended

99391 Established patient periodic preventive medicine examination infant younger than 1 year Extended

99392 Established patient periodic preventive medicine examination, age 1 through 4 years Extended

4.

Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from Federal and State agencies.

Commercial & ASO Existing and Extended Telemedicine Policy Codes

99393 Established patient periodic preventive medicine examination, age 5 through 11 years Extended

99394 Established patient periodic preventive medicine examination, age 12 through 17 years Extended

99395 Established patient periodic preventive medicine examination age 18-39 years Extended

99396 Established patient periodic preventive medicine examination age 40-64 years Extended

99397 Established patient periodic preventive medicine examination, age 65 years and older Extended

99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

Existing

99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes Existing

99408 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes

Existing

99409 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes

Existing

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

Extended

99422 Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes

Extended

99423 Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

Extended

99441 Physician telephone patient service, 5-10 minutes of medical discussion Extended

99442 Physician telephone patient service, 11-20 minutes of medical discussion Extended

99443 Physician telephone patient service, 21-30 minutes of medical discussion Extended

99495 Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge

Existing

99496 Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge

Existing

99497 Advance care planning by the physician or other qualified health care professional Existing

99498 Advance care planning by the physician or other qualified health care professional (add-on code)

Existing

0362T Behavior identification supporting assessment for patient exhibiting destructive behavior, each 15 minutes of technicians' face-to-face time

Extended

0373T daptive behavior treatment with protocol modification for patient exhibiting destructive behavior, each 15 minutes of technicians' face-to-face time

Extended

G0108 Diabetes outpatient self-management training services, individual, per 30 minutes Existing

G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes

Existing

G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen, each 15 minutes

Existing

G0296 Counseling visit to discuss need for lung cancer screening (LDCT) using low dose CT scan (service is for eligibility determination and shared decision making)

Existing

G0396 Alcohol and/or substance (other than tobacco) abuse structured assessment (eg, AUDIT, DAST). and brief intervention 15 to 30 minutes

Existing

G0397 Alcohol and/or substance (other than tobacco) abuse structured assessment (eg, AUDIT, DAST). and intervention, greater than 30 minutes

Existing

G0406 Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth

Existing

G0407 Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth

Existing

5.

Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from Federal and State agencies.

Commercial & ASO Existing and Extended Telemedicine Policy Codes

G0408 Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth

Existing

G0420 Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour

Existing

G0421 Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour

Existing

G0425 Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth

Existing

G0426 Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth

Existing

G0427 Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth

Existing

G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit Existing

G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

Existing

G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes Extended

G0447 Face-to-face behavioral counseling for obesity, 15 minutes Extended

G0459 Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy

Existing

G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services (add-on code)

Existing

G0508 Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth

Existing

G0509 Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth

Existing

G0513 Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (add-on code)

Existing

G0514 Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (add-on code)

Existing

G2010 Remote evaluation of recorded video and/or images submitted by an established patient Extended

G2012 Brief communication technology-based service, e.g., virtual check-in, 5-10 minutes of medical discussion

Extended

G2061 Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

Extended

G2062 Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes

Extended

G2063 Qualified nonphysician qualified health care professional assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

Extended

H0001 Alcohol and drug assessment Extended

H0002 Behavioral health screening to determine eligibility for admission to treatment program Extended

H0004 Behavioral health counseling and therapy, per 15 minutes Extended

H0006 HF Navigator services (Maintenance) Extended

H0006 HF HG Navigator psychosocial assessment & patient-specific Treatment plan development (Initiation)

Extended

H0006 HF SU Navigator services (Stabilization) Extended

6.

Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from Federal and State agencies.

Commercial & ASO Existing and Extended Telemedicine Policy Codes

H0014 Alcohol and/or drug services; ambulatory detoxification Extended

H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) Extended

H0020 HF Methadone (per diem) Extended

H0020 HF 26 Methadone (bundled) Extended

H0032 Mental Health service plan development by a non-physician, per 15 minutes Extended

H0033 HF non-Methadone (per diem) Extended

H0033 HF 26 non-Methadone (bundled) Extended

H0047 Alcohol and/or other drug abuse services, not otherwise specified Extended

7.

Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from Federal and State agencies.

Commercial & ASO Existing and Extended Telemedicine Policy Codes