Physicians must know telehealth service codes for 2023

Question: Can you provide us with the new telehealth service codes for 2023?

A: For 2023 Medicare Telehealth Services, the Centers for Medicare and Medicaid Services (CMS) is adding new Health Care Common Procedures Coding System (HCPCS) codes to Medicare’s list of telehealth services, specifically the following HCPCS codes.

Extended service codes

G0316: service(s) evaluating and administering long-term hospital inpatient care beyond total initial service time (when initial service is selected using time on initial service date); Every additional 15 minutes by a physician or qualified healthcare professional, with or without direct patient contact (separate list plus CPT codes 99223And 99233And 99236 for hospital inpatient or observational care evaluation and management services)

G0317: Nursing facility assessment and management service(s) for extended periods beyond the total initial service time (when initial service selection is made using the time on initial service date); Every additional 15 minutes by a physician or qualified healthcare professional, with or without direct patient contact (separate list plus CPT codes 99306And 99310 for nursing facility assessment and management services)

G0318: home assessment and management service(s) for extended periods of time beyond the total time for the primary service (when the initial service is selected using the time on the initial service date); Every additional 15 minutes by a physician or qualified healthcare professional, with or without direct patient contact (separate list plus CPT codes 99345And 99350 for home or residence appraisal and management services)

For each of these codes, consider the applicable place of service – inpatient/observation, nursing facility, or home/residential. The original codes for these services should be chosen on the basis of time, rather than medical decision making, and these codes should not be charged for any time less than 15 minutes.

Chronic pain management and treatment packages

G3002: Management and treatment of chronic pain, monthly package including diagnosis;

• Administer a validated pain-rating scale or tool;
• Develop, implement, review and/or maintain a person-centered plan of care that incorporates strengths, goals, clinical needs and desired outcomes;
• Comprehensive treatment management
• Facilitate and coordinate any necessary behavioral health treatment;
• Medication management
• Facilitate and coordinate any necessary behavioral health treatment;
• pain counseling and health education;
• any necessary crisis care associated with chronic pain; Wow ,
• Coordinating ongoing communication and care among the relevant practitioners providing care (eg physical and occupational therapy, complementary and integrative approaches, and community-based care), as appropriate.

The required initial face-to-face visit of at least 30 minutes provided by a physician or other qualified health professional; The first 30 minutes to be delivered in person by a physician or other qualified healthcare professional, each calendar month. (When using G300230 minutes must be met or exceeded.)

G3003: Every additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, each calendar month (separate list plus code G3002). (When using the G3003, 15 minutes must be met or exceeded.)

CMS main points, per The Alliance to Advance Comprehensive Integrated Pain Managementincludes:

1. CMS specifically states, “We are making it clear that clinicians will be required to provide all appropriate items of the code package, but we are also making it clear that we do not expect all items of the code package to be appropriate for each patient.”
2. While the CMS will require an initial face-to-face visit in order for the CPM codes to be billable, it will not require personal sponsorship for each subsequent visit, whether monthly or at some other time.
3. While the CMS will require billing providers to use a validated pain measure, it will not require the use of any single pain assessment measure, “because no particular tool or set of tools can assess the complex nature of pain experience in all individuals, nor Direct treatment appropriately.

Additional telehealth codes continued through 2023

CMS maintains many services temporarily available as telehealth for the duration of the public health emergency (PHE) through 2023.

The status of more than 40 codes on Medicare’s telehealth list will change to “Available through December 31, 2023.” The CMS extends the period of time that services are temporarily included in Medicare’s list of telehealth services during PHE. CMS is implementing 151-day extensions to Medicare’s telehealth flexibility in the 2022 Consolidated Appropriations Act (CAA), including allowing telehealth to be provided in any geographic area and at any location of origin, including the beneficiary’s home. It also allows certain services to be provided via voice communication systems only, and allows physiotherapists, occupational therapists, speech-language pathologists, and audiologists to provide telehealth services. The CAA is also delaying in-person visitation requirements for mental health services provided via telehealth until 152 days after the end of PHE.

For 2023, CMS continues that telehealth claims may still be billed with a place of service indication of what they would have been if the service had been billed for an in-person visit. These claims will require Amendment 95 to define them as services performed and provided as telehealth through late end of fiscal year 2023 or end of year in which PHE ends.

The list of codes that have been added to the list of telehealth services can be found at: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

Renee Dowling is a compliance auditor at Sansum Clinic, LLC, in Santa Barbara, California.