Telehealth Update Medicare - 2022

The listed CPT codes are covered in telehealth and changes are effective from dated on June 16, 2022

Medicare telehealth services require that the services occur over real-time audio and visual interactive telecommunications. For purposes of diagnosis, evaluation, or treatment of mental health disorders.

If the patient doesn’t have the technical capacity or the availability of real-time audio and visual interactive telecommunications, or they don’t consent to the use of real-time video technology, we allow audio-only communication for telehealth mental health services to established patients located in their homes.

After the PHE ends, Telehealth Mental Health services may include new or established patients so long as an in-person, face-to-face, non-telehealth service takes place within 6 months of the telehealth mental health services.

This means that all telehealth mental health patients should have had a first in-person visit no later than 6 months after the PHE.

After the PHE and after the initial 6-month in-person visit, all telehealth mental health patients must have a subsequent non-telehealth in-person visit within 12 months of the initial 6-month in-person visit date

During the initial 6-month in-person visit or during the subsequent 12-month in-person visits, if the original telehealth practitioner is unavailable for the face-to-face visit, we allow the clinician’s colleague in the same subspecialty and in the same group practice, to provide the in-person, non-telehealth service to the patient.

There are two additional modifiers for the current year in 2022 that relate to telehealth mental health services. The modifiers are, 

• FQ - A telehealth service was furnished using real-time audio-only communication technology

• FR - A supervising practitioner was present through a real-time two-way, audio/video communication technology

Click Here to Refer Telehealth CPT Codes

COVID-19 updates UnitedHealthcare

Temporary cost-share waivers extended to Oct. 17, 2021

The national public health emergency has been extended from July 19, 2021, to Oct. 17, 2021. Below is an overview of how that extension affects temporary provisions for COVID-19 testing and testing-related visits.

Individual Exchange, Individual and Group Market health plans: 

• From Feb. 4, 2020, through the national public health emergency period, United Healthcare is waiving cost-sharing for in-network and out-of-network COVID-19 tests and testing-related visits.

Medicare Advantage: 

• From Feb. 4, 2020, through the national public health emergency period, United Healthcare is waiving cost-sharing for in-network and out-of-network tests for COVID-19, including testing-related telehealth visits.

Medicaid: 

• State-specific rules and other state regulations may apply. For Medicaid and other state-specific regulations, please refer to your state-specific website or your state’s United Healthcare Community Plan website. 

COVID - 19 Vaccine Updates - May'2021

The FDA is recommended to use "Pfizer-BioNTech" COVID-19 vaccine for adolescents aged 12-15 years.  

On May 12, 2021, the Advisory Committee on Immunization Practices (ACIP) recommended the use of the "Pfizer-BioNTech" COVID-19 vaccine in adolescents aged 12-15 years, and CDC Director Rochelle Walensky adopted this ACIP recommendation.

All COVID-19 vaccination providers are directed and required to make available and administer COVID-19 vaccine to all persons eligible to receive the COVID-19 vaccine consistent with the applicable Emergency Use Authorizations for such products.   

The COVID-19 vaccines themselves are free to everyone 12 years and older in the United States, but providers incur costs associated with administering them, training staff, and storing the vaccine. 

If these services are not covered by a patient’s health plan or only partially covered, providers are not allowed to balance bill the patients.

Claims for reimbursement will be priced as described below for eligible services,

Vaccine administration fees will be priced based on national Medicare rates for administering the COVID-19 vaccine (not geographically adjusted) and are outlined below,

For dates of service through March 14, 2021:-

• Administration of a single-dose COVID-19 vaccine - $28.39

• Administration of the first dose of a COVID-19 vaccine requiring a series of two or more doses - $16.94

• Administration of the final dose of a COVID-19 vaccine requiring a series of two or more doses - $28.39

For dates of service on or after March 15, 2021:-

• Administration (per dose) of a COVID-19 vaccine - $40.00

• Reimbursement will be based on the incurred date of service.

Click here for COVID-19 Lab Code Updates

HRSA COVID-19 Coverage Assistance Fund and Rural Health Clinic (RHC) Payment Limits

HRSA COVID-19 Coverage Assistance Fund 

The Biden-Harris Administration is providing free access to COVID-19 vaccines for every adult living in the United States. 

Accordingly, the Health Resources and Services Administration’s (HRSA) COVID-19 Coverage Assistance Fund (CAF) will cover the costs of administering COVID-19 vaccines to patients whose health insurance doesn’t cover vaccine administration fees, or does but typically has patient cost-sharing. 

While patients cannot be billed directly for the COVID-19 vaccine fees, costs to health care providers on the front lines for administering COVID-19 vaccines to underinsured patients will now be fully covered through CAF, subject to available funding. 

As vaccination efforts accelerate, patients will increasingly gain access to COVID-19 vaccines at locations near where they live with providers they trust.

Providers are eligible for claims reimbursement if they have administered Food and Drug Administration (FDA) authorized COVID-19 vaccines under an Emergency Use Authorization (EUA) or FDA-licensed COVID-19 vaccines under a Biologics License Application (BLA) to individuals whose health plan does not cover vaccine administration fees, or does but typically has patient cost-sharing.

The eligible providers will be reimbursed at national Medicare rates for vaccine administration fees, and for any patient cost-sharing related to vaccination, including,

• Co-pays
• Deductibles,
• Co-insurance

Rural Health Clinic (RHC) Payment Limits

Effective January 1, 2021, the RHC payment limit per visit for Calendar Year (CY) 2021 is $87.52. This payment limit applies to independent RHCs and RHCs that are provider-based to a hospital with 50 or more beds.

Beginning April 1, 2021, the RHCs will begin to receive an increase in their payment limit per visit over an 8-year period, with a prescribed amount for each year from 2021, through 2028. 

Then, in subsequent years, the limit is updated by the percentage increase in MEI applicable to primary care services furnished as of the first day of that year.

The RHC payment limit per visit over an 8-year period is as follows,

• In 2021, after March 31, at $100 per visit
• In 2022, at $113 per visit
• In 2023, at $126 per visit
• In 2024, at $139 per visit
• In 2025, at $152 per visit
• In 2026, at $165 per visit
• In 2027, at $178 per visit
• In 2028, at $190 per visit

New Updates for COVID-19 Lab Codes

Modifier QW

The Medicare and Medicaid only pay for laboratory tests performed in certified facilities, each claim for a HCPCS code that is considered a CLIA laboratory test is currently edited at the CLIA certificate level. 

To be recognized as a test that can be performed in a facility having a CLIA certificate of waiver for listed below CPT codes and the modifier QW must be added.

The CMS released updates for adding modifier QW for COVID-19 lab codes with effective date of service.

• The Medicare contractor shall permit the use of code 87636 QW for claims submitted by facilities with a valid, current CLIA certificate of waiver with dates of service on or after October 6, 2020 and effective from July 1, 2021

• The Medicare contractor shall permit the use of code 87428 QW for claims submitted by facilities with a valid, current CLIA certificate of waiver with dates of service on or after November 10, 2020.

• The Medicare contractor shall permit the use of code 87811 QW for claims submitted by facilities with a valid, current CLIA certificate of waiver with dates of service on or after October 6, 2020.

• The Medicare contractor shall permit the use of code 87635 QW for claims submitted by facilities with a valid, current CLIA certificate of waiver with dates of service on or after March 20, 2020.
  

New Codes Effective November 10, 2020

• 87428 - Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARSCoV-2 [COVID-19]) and influenza virus types A and B

New Codes Effective October 6, 2020 

The listed new codes are on the national HCPCS file with an effective date of October 6, 2020 and do not need to be manually added to the HCPCS files by the MACs. 

However, these new codes are contractor priced (where applicable) until they are nationally priced and undergoes the CLFS annual payment determination process in accordance with the Social Security Act § 1833(h)(8), § 1834A(c) and § 1834(A)(f).

• 87636 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique.

• 87637 - Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique

• 87811 -  Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group B severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).

COVID-19 news National public health emergency extended to July 19, 2021

The national public health emergency has been extended from April 20, 2021, to July 19, 2021. Below is an overview of how that extension affects temporary provisions for COVID-19 testing and testing-related services for major payers

UHC

Individual Exchange, Individual and Group Market health plans: From Feb. 4, 2020 through the national public health emergency period, UnitedHealthcare is waiving cost sharing for in-network and out-of-network COVID-19 tests and testing-related services, including testing-related telehealth visits.

Medicare Advantage: From Feb. 4, 2020 through the national public health emergency period, UnitedHealthcare is waiving cost sharing for in-network and out-of-network tests for COVID-19.

Medicaid: State-specific rules and other state regulations may apply. For Medicaid and other state-specific regulations, please refer to your state-specific website or your state’s UnitedHealthcare Community Plan website, if applicable.

 

Aetna

Aetna’s liberalized coverage of Commercial telemedicine services, as described in its telemedicine policy, will continue until further notice

For Individual Aetna Medicare Advantage members, copays are waived for in-network telehealth visits for primary care through the end of the Public Health Emergency.

Cigna

The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place until the end of Public Health Emergency (PHE) period said by Cigna

Interim accommodations for credentialing are extended through the end of the public health emergency period, currently through April 20, 2021

Humana

To support providers with caring for their Humana patients while promoting both patient and provider safety, we have updated our existing telehealth policy for the duration of the COVID-19 public health emergency (PHE)

Temporary expansion of telehealth service scope and reimbursement rules

To ease systemic burdens arising from COVID-19 and support shelter-in-place orders, Humana is encouraging the use of telehealth services to care for its members. 

Please refer to CMS, state and plan coverage guidelines for additional information regarding services that can be delivered via telehealth

Repayment of COVID-19 Accelerated and Advance Payments

All Medicare providers and suppliers who requested and received CAAPs that we began recovering those payments as early as March 30, 2021, depending upon the 1 year anniversary of when you received your first payment. 

It also gives information on how to identify recovered payments. 

Title V (Section 2501) of the Continuing Appropriations Act, 2021 and Other Extensions Act, enacted on October 1, 2020, amended the CAAP repayment terms for all providers and suppliers who requested and received CAAPs during the COVID-19 PHE and established a lower interest rate of 4% for any demanded overpayments to recover CAAP balances due. 

The CAAP repayment terms provide as follows,

• Repayment begins 1 year starting from the date we issued your first CAAP.

• Beginning 1 year from the date we issued the CAAP and continuing for 11 months, we’ll recover the CAAP from Medicare payments due to providers and suppliers at a rate of 25%.

• After the end of this 11 month period, we’ll continue to recover the remaining CAAP from Medicare payments due to providers and suppliers at a rate of 50% for 6 months.

• After the end of the 6 month period, your Medicare Administrative Contractor (MAC) will issue you a demand letter for full repayment of any remaining balance of the CAAP. 

• If we don’t receive a payment within 30 days, interest will accrue at the rate of 4% from the date your MAC issues you the demand letter. 

• After that, we’ll assess interest for each full 30-day period that you fail to repay the balance.

If you received an accelerated or advance payment, CMS will begin to recoup any outstanding balance from any payments due to you from your Medicare claims. 

This began as soon as March 30, 2021, depending upon the 1 year anniversary of when you received your first payment

Revised Guidelines for CPT 99441 - 99443

CMS will pay for phone calls using codes 99441—99443. The 4/30/20 rule adds these to the telehealth list and increased payment for these services

These codes previously had a non-covered status and the Physicians, nurse practitioners, and physician assistants should use codes 99441—99443

• 99441 - Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
• 99442 - Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
• 99443 - Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion

CMS continues did not add 98966–98968 to the telehealth list,

Other qualified health care professionals who may bill Medicare for their services, such as registered dietitians, social workers, speech language pathologists and physical and occupational therapists should use codes 98966—98968

• 98966 - Telephone assessment and management service provided by a qualified non physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
• 98967 - Telephone assessment and management service provided by a qualified non physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
• 98968 - Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion

New! 99441–99443 have been added to the telehealth list, so use the place of service that would have been furnished. In most cases, this will be place of service office (11) or outpatient department (19, 22). Since they are now telehealth services, add modifier 95

CMS has changed the rates for codes 99441–99443 to the rates for 99212–99214.

***Telephone codes 99441–99443 require audio only but will pay at the rates of 99212–99214 

UHC Telehealth Updates

The CMS fee schedule changes for audio-only codes, providers will continue to be reimbursed for audio-only visits at the rate they would receive for audio-video or in-person codes. 

The CMS rates for audio-only telephonic evaluation and management (E/M) codes, as well as virtual check-ins (which may be done by telephone) and e-visits for established patients for dates of service on or after March 1, 2020.

Audio-only visits and other services not requiring video technology include 

Audio-only (telephone) E/M services 

• 99441 - Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
• 99442 - Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
• 99443 - Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion 
  

Online digital E/M services/e-visits 

• 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
• 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
• 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
• 98970 - Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
• 98971 - Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
• 98972 - Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
  

Virtual check Codes

• G2010 - Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment
• G2012 - Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

And additional codes starting Jan. 1, 2021

• G2250 - Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment
• G2251 - Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
• G2252 - Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
  

Audio and video visits and other services requiring video technology include,

• The service rendered through “real-time;” a two-way, face-to-face interaction between a patient and a provider using audiovisual communications technology.
• Office and or Outpatients CPT codes 99201 - 99215
  

Place Of Service

 

United HealthCare initially covered the service when submitted with a place of service with modifier 95, but effective from Jan 1st, 2021, the UHC denied as the service billed with an inappropriate place of service or invalid.

The UHC shared the billing guidelines for telehealth states as following,

Starting Jan 1st, 2021, eligible telehealth service will be considered for reimbursement when reported with a place of service (POS) 02. Modifier 95, GT, GQ, GO not required and the place of service 02 will be considered the service rendered through telehealth.

Telehealth CPT

Telehealth Services

The below list of services payable under the Medicare Physician Fee Schedule when furnished via telehealth during the PHE (Public Health Emergency)

CPT Short Descriptor

77427 Radiation tx management x5

90785 Psytx complex interactive

90791 Psych diagnostic evaluation

90792 Psych diag eval w/med srvcs

90832 Psytx w pt 30 minutes

90833 Psytx w pt w e/m 30 min

90834 Psytx w pt 45 minutes

90836 Psytx w pt w e/m 45 min

90837 Psytx w pt 60 minutes

90838 Psytx w pt w e/m 60 min

90839 Psytx crisis initial 60 min

90840 Psytx crisis ea addl 30 min

90845 Psychoanalysis

90846 Family psytx w/o pt 50 min

90847 Family psytx w/pt 50 min

90853 Group psychotherapy

90875 Psychophysiological therapy

90951 Esrd serv 4 visits p mo <2yr

90952 Esrd serv 2-3 vsts p mo <2yr

90953 Esrd serv 1 visit p mo <2yrs

90954 Esrd serv 4 vsts p mo 2-11

90955 Esrd srv 2-3 vsts p mo 2-11

90956 Esrd srv 1 visit p mo 2-11

90957 Esrd srv 4 vsts p mo 12-19

90958 Esrd srv 2-3 vsts p mo 12-19

90959 Esrd serv 1 vst p mo 12-19

90960 Esrd srv 4 visits p mo 20+

90961 Esrd srv 2-3 vsts p mo 20+

90962 Esrd serv 1 visit p mo 20+

90963 Esrd home pt serv p mo <2yrs

90964 Esrd home pt serv p mo 2-11

90965 Esrd home pt serv p mo 12-19

90966 Esrd home pt serv p mo 20+

90967 Esrd svc pr day pt <2

90968 Esrd svc pr day pt 2-11

90969 Esrd svc pr day pt 12-19

90970 Esrd svc pr day pt 20+

92002 Eye exam new patient

92004 Eye exam new patient

92012 Eye exam establish patient

92014 Eye exam&tx estab pt 1/>vst

92507 Speech/hearing therapy

92508 Speech/hearing therapy

92521 Evaluation of speech fluency

92522 Evaluate speech production

92523 Speech sound lang comprehen

92524 Behavral qualit analys voice

92526 Oral function therapy

92550 Tympanometry & reflex thresh

92552 Pure tone audiometry air

92553 Audiometry air & bone

92555 Speech threshold audiometry

92556 Speech audiometry complete

92557 Comprehensive hearing test

92563 Tone decay hearing test

92565 Stenger test pure tone

92567 Tympanometry

92568 Acoustic refl threshold tst

92570 Acoustic immitance testing

92587 Evoked auditory test limited

92601 Cochlear implt f/up exam <7

92602 Reprogram cochlear implt <7

92603 Cochlear implt f/up exam 7/>

92604 Reprogram cochlear implt 7/>

92607 Ex for speech device rx 1hr

92608 Ex for speech device rx addl

92609 Use of speech device service

92610 Evaluate swallowing function

92625 Tinnitus assessment

92626 Eval aud funcj 1st hour

92627 Eval aud funcj ea addl 15

93750 Interrogation vad in person

93797 Cardiac rehab

93798 Cardiac rehab/monitor

94002 Vent mgmt inpat init day

94003 Vent mgmt inpat subq day

94004 Vent mgmt nf per day

94005 Home vent mgmt supervision

94664 Evaluate pt use of inhaler

95970 Alys npgt w/o prgrmg

95971 Alys smpl sp/pn npgt w/prgrm

95972 Alys cplx sp/pn npgt w/prgrm

95983 Alys brn npgt prgrmg 15 min

95984 Alys brn npgt prgrmg addl 15

96105 Assessment of aphasia

96110 Developmental screen w/score

96112 Devel tst phys/qhp 1st hr

96113 Devel tst phys/qhp ea addl

96116 Nubhvl xm phys/qhp 1st hr

96121 Nubhvl xm phy/qhp ea addl hr

96125 Cognitive test by hc pro

96127 Brief emotional/behav assmt

96130 Psycl tst eval phys/qhp 1st

96131 Psycl tst eval phys/qhp ea

96132 Nrpsyc tst eval phys/qhp 1st

96133 Nrpsyc tst eval phys/qhp ea

96136 Psycl/nrpsyc tst phy/qhp 1st

96137 Psycl/nrpsyc tst phy/qhp ea

96138 Psycl/nrpsyc tech 1st

96139 Psycl/nrpsyc tst tech ea

96156 Hlth bhv assmt/reassessment

96158 Hlth bhv ivntj indiv 1st 30

96159 Hlth bhv ivntj indiv ea addl

96160 Pt-focused hlth risk assmt

96161 Caregiver health risk assmt

96164 Hlth bhv ivntj grp 1st 30

96165 Hlth bhv ivntj grp ea addl

96167 Hlth bhv ivntj fam 1st 30

96168 Hlth bhv ivntj fam ea addl

96168 Hlth bhv ivntj fam ea addl

96170 Hlth bhv ivntj fam wo pt 1st

96171 Hlth bhv ivntj fam w/o pt ea

97110 Therapeutic exercises

97112 Neuromuscular reeducation

97116 Gait training therapy

97129 Ther ivntj 1st 15 min

97130 Ther ivntj ea addl 15 min

97150 Group therapeutic procedures

97151 Bhv id assmt by phys/qhp

97152 Bhv id suprt assmt by 1 tech

97153 Adaptive behavior tx by tech

97154 Grp adapt bhv tx by tech

97155 Adapt behavior tx phys/qhp

97156 Fam adapt bhv tx gdn phy/qhp

97157 Mult fam adapt bhv tx gdn

97158 Grp adapt bhv tx by phy/qhp

97161 Pt eval low complex 20 min

97162 Pt eval mod complex 30 min

97163 Pt eval high complex 45 min

97164 Pt re-eval est plan care

97165 Ot eval low complex 30 min

97166 Ot eval mod complex 45 min

97167 Ot eval high complex 60 min

97168 Ot re-eval est plan care

97530 Therapeutic activities

97535 Self care mngment training

97542 Wheelchair mngment training

97750 Physical performance test

97755 Assistive technology assess

97760 Orthotic mgmt&traing 1st enc

97761 Prosthetic traing 1st enc

97802 Medical nutrition indiv in

97803 Med nutrition indiv subseq

97804 Medical nutrition group

99202 Office/outpatient visit new

99203 Office/outpatient visit new

99204 Office/outpatient visit new

99205 Office/outpatient visit new

99211 Office/outpatient visit est

99212 Office/outpatient visit est

99213 Office/outpatient visit est

99214 Office/outpatient visit est

99215 Office/outpatient visit est

99217 Observation care discharge

99218 Initial observation care

99219 Initial observation care

99220 Initial observation care

99221 Initial hospital care

99222 Initial hospital care

99223 Initial hospital care

99224 Subsequent observation care

99225 Subsequent observation care

99226 Subsequent observation care

99231 Subsequent hospital care

99232 Subsequent hospital care

99233 Subsequent hospital care

99234 Observ/hosp same date

99235 Observ/hosp same date

99236 Observ/hosp same date

99238 Hospital discharge day

99239 Hospital discharge day

99281 Emergency dept visit

99282 Emergency dept visit

99283 Emergency dept visit

99284 Emergency dept visit

99285 Emergency dept visit

99291 Critical care first hour

99292 Critical care addl 30 min

99304 Nursing facility care init

99305 Nursing facility care init

99306 Nursing facility care init

99307 Nursing fac care subseq

99308 Nursing fac care subseq

99309 Nursing fac care subseq

99310 Nursing fac care subseq

99315 Nursing fac discharge day

99316 Nursing fac discharge day

99324 Domicil/r-home visit new pat

99325 Domicil/r-home visit new pat

99326 Domicil/r-home visit new pat

99327 Domicil/r-home visit new pat

99328 Domicil/r-home visit new pat

99334 Domicil/r-home visit est pat

99335 Domicil/r-home visit est pat

99336 Domicil/r-home visit est pat

99337 Domicil/r-home visit est pat

99341 Home visit new patient

99342 Home visit new patient

99343 Home visit new patient

99344 Home visit new patient

99345 Home visit new patient

99347 Home visit est patient

99348 Home visit est patient

99349 Home visit est patient

99350 Home visit est patient

99354 Prolong e&m/psyctx serv o/p

99355 Prolong e&m/psyctx serv o/p

99356 Prolonged service inpatient

99357 Prolonged service inpatient

99406 Behav chng smoking 3-10 min

99407 Behav chng smoking > 10 min

99441 Phone e/m phys/qhp 5-10 min

99442 Phone e/m phys/qhp 11-20 min

99443 Phone e/m phys/qhp 21-30 min

99468 Neonate crit care initial

99469 Neonate crit care subsq

99471 Ped critical care initial

99472 Ped critical care subsq

99473 Self-meas bp pt educaj/train

99475 Ped crit care age 2-5 init

99476 Ped crit care age 2-5 subsq

99477 Init day hosp neonate care

99478 Ic lbw inf < 1500 gm subsq

99479 Ic lbw inf 1500-2500 g subsq

99480 Ic inf pbw 2501-5000 g subsq

99483 Assmt & care pln pt cog imp

99495 Trans care mgmt 14 day disch

99496 Trans care mgmt 7 day disch

99497 Advncd care plan 30 min

99498 Advncd care plan addl 30 min

0373T Adapt bhv tx ea 15 min

S9152 Speech therapy, re-eval

0362T Bhv id suprt assmt ea 15 min

G0108 Diab manage trn  per indiv

G0109 Diab manage trn ind/group

G0270 Mnt subs tx for change dx

G0296 Visit to determ ldct elig

G0396 Alcohol/subs interv 15-30mn

G0397 Alcohol/subs interv >30 min

G0406 Inpt/tele follow up 15

G0407 Inpt/tele follow up 25

G0408 Inpt/tele follow up 35

G0410 Grp psych partial hosp 45-50

G0420 Ed svc ckd ind per session

G0421 Ed svc ckd grp per session

G0422 Intens cardiac rehab w/exerc

G0423 Intens cardiac rehab no exer

G0424 Pulmonary rehab w exer

G0425 Inpt/ed teleconsult30

G0426 Inpt/ed teleconsult50

G0427 Inpt/ed teleconsult70

G0438 Ppps, initial visit

G0439 Ppps, subseq visit

G0442 Annual alcohol screen 15 min

G0443 Brief alcohol misuse counsel

G0444 Depression screen annual

G0445 High inten beh couns std 30m

G0446 Intens behave ther cardio dx

G0447 Behavior counsel obesity 15m

G0459 Telehealth inpt pharm mgmt

G0506 Comp asses care plan ccm svc

G0508 Crit care telehea consult 60

G0509 Crit care telehea consult 50

G0513 Prolong prev svcs, first 30m

G0514 Prolong prev svcs, addl 30m

G2086 Off base opioid tx 70min

G2087 Off base opioid tx, 60 m

G2088 Off base opioid tx, add30

G2211 Complex E/M visit add on

G2212 Prolong outpt/office vis

G9685 Acute nursing facility care

COVID-19 Vaccine Updates

The AMA released on Jan 19, 2021,  A fourth COVID-19 vaccine code has been released by the American Medical Association, along with an administration code.  

91303 - Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use

0031A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative-free, 5x1010 viral particles/0.5mL dosage, single dose

The Janssen COVID-19 vaccine EUA/approval, providers will report 0031A for the administration of vaccine 91303

Note that Janssen is a single-dose vaccine, requiring a single administration. Providers will not have any reason to report 0031A more than once for a patient in any given year. 

The AMA has also released a National Drug Code: NDC 59676-0580-05.  

The CMS released a list of CPT codes for COVID-19 vaccines which is administered through the intramuscular and approved the below Vaccine/Product Name 

• Pfizer
• Moderna 
• AstraZeneca
• Janssen

Pfizer

91300 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use

0001A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose

0002A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose

Moderna 

 

91301 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use

0011A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose

0012A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose

AstraZeneca

 

91302 - Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use

0021A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage; first dose

0022A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage; second dose

 

Janssen

 

91303 - Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use

0031A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, single dose

For Telehealth