Video Visits Billing, Coding and Regulations Information

This is a list of eligible CPT/HCPCS codes.

• Use modifier -95 to claim line-item services provided via telehealth.
  • Use POS code 10 for telehealth services provided in the patient's home - Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.
  • Use POS 02 for telehealth services provided other than in patient's home - Patient is not located in their home when receiving health services or health related services through telecommunication technology.
• Modifier -95 should not be used with virtual check-ins (98016) or digital evaluations (99421-99423). It is for use with all other telehealth codes that use synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.
• -GQ: Clinicians participating in the federal telehealth demonstration programs in Alaska or Hawaii must submit the appropriate CPT or HCPCS code for the professional service along with the modifier GQ, “via asynchronous telecommunications system.”
• -G0: Use of telehealth for purposes of diagnosing, evaluating, or treating stroke.
• -GT: Medicare stopped using modifier -GT in 2017 when the place of service code 02 (telehealth) was introduced. However, private payers may still be using the modifier -GT.

New in CY 2025: CPT code 98016 will replace HCPCS code G2012 for brief virtual check-ins

Rules:

• Established patients only
• Must be a physician or other qualified health care professional who can report E/M services.
• If an E/M service is provided within the defined time frames, then the virtual check-in is bundled into that E/M service. It would be considered pre- or post-visit time of the associated E/M service and thus not separately billable.
• Should be initiated by the patient since a copay is required. Verbal consent to bill and documentation is required.

Codes:

• No modifier needed as these are technology-based codes.

Telehealth-specific codes for the following use cases:

• Can be done synchronously and asynchronously and audio/video phones can be used.
• The patient can initiate a virtual check-in; the practice can inform the patient about their options. If the patient calls back within 7 days, the time from the virtual check-in can be added to the digital E/M code and only the digital E/M code is billed
• If the patient initiates a call to the physician’s office, this would qualify for the remote check-in code (98016); the time for the remote (virtual) check-in can be counted toward 99421-3 only if and when the patient calls back, so it is important to document the time. (See CPT book for details on when the 7 days begins, how to count time, which “qualified non-physician health professionals” it applies to, and other documentation requirements.)

Rules:

• Must be patient initiated.
• Cost sharing applies.
• Use only once per 7-day period. If the patient presents a new, unrelated problem during the 7-day period of an online digital E/M service, the time is added to the cumulative service time for those 7 days.
• Clinical staff time is not calculated as part of cumulative time.
• Service time must be more than 5 minutes.
• Do not count time otherwise reported with other services.
• Do not report on a day when the physician or other qualified health care professional reports other E/M services.
• Do not report when billing remote monitoring, CCM, TCM, care plan oversight, and codes for supervision of patient in home, domiciliary or rest home, etc. for the same communication[s]).
• Do not report for home and outpatient INR monitoring when reporting 93792, 93793.
• No modifier needed as these are technology based codes.

States vary widely regarding licensure and private payer and Medicaid policies for telehealth.

• The Center for Connected Health Policy (CCHP) is an excellent resource for keeping up with state regulations. CCHP tracks Private Payer Requirements and Telehealth Policies by State. Its information covers Medicaid clarification, waivers, telehealth guidance, prescription and consent waivers, private payer requirements, and cross-state licensing.
• The American Telemedicine Association (ATA) tracks state activity on telehealth including state legislation.
• CMS maintains various resources on State Medicaid Telehealth Coverage, Private Insurance Coverage for Telehealth, and licensure.