Question: Could you kindly provide us with the updated telehealth services codes for the year 2023?
Response: Regarding Medicare Telehealth Services for the year 2023, the Centers for Medicare and Medicaid Services (CMS) are introducing fresh Healthcare Common Procedure Coding System (HCPCS) codes to the compilation of Medicare telehealth services. More precisely, the subsequent HCPCS codes will be included
Prolonged Service Codes
HCPCS Code G0316: Additional time-based evaluation and management services for prolonged hospital inpatient or observation care beyond the allotted duration of the primary service (when time was the criterion for selecting the primary service); each extra 15-minute increment performed by the physician or qualified healthcare professional, with or without direct patient interaction (to be listed separately along with CPT code 99223, CPT code 99233, and CPT code 99236 for hospital inpatient or observation care evaluation and management services).
HCPCS Code G0317: Extra time-based evaluation and management services for prolonged nursing facility care surpassing the allocated time for the primary service (when time was the basis for selecting the primary service); every supplementary 15-minute interval conducted by the physician or qualified healthcare professional, with or without direct patient engagement (to be listed separately along with CPT code 99306, CPT code 99310 for nursing facility evaluation and management services).
HCPCS Code G0318: Further time-based evaluation and management services for extended home or residence care beyond the scheduled time for the primary service (when time was the criterion for selecting the primary service); each additional 15-minute segment performed by the physician or qualified healthcare professional, with or without direct patient interaction (to be listed separately along with CPT code 99345,CPT code 99350 for home or residence evaluation and management services).
When using any of these codes, it’s crucial to consider the relevant place of service – either inpatient/observation, nursing facility, or home/residence. Note that the initial codes for these services must have been chosen based on time, rather than medical decision-making, and these codes should not be utilized for durations shorter than 15 minutes
Integrated Approaches to Chronic Pain Management and Treatment Bundles
G3002: Comprehensive monthly package for chronic pain management and treatment, encompassing:
- Application of a validated pain rating scale or tool;
- Creation, execution, modification, and/or upkeeping of an individualized care plan centered around the individual’s strengths, objectives, clinical requirements, and sought-after results;
- Comprehensive management of treatment;
- Facilitation and organization of any imperative behavioral health interventions;
- Oversight of medication regimen;
- Facilitation and organization of any imperative behavioral health interventions;
- Provision of counseling for pain and health literacy;
- Addressing any necessary chronic pain-related urgent situations;
- Continuous communication and care coordination among relevant practitioners delivering care (such as physical therapists, occupational therapists, integrative methodologies, and community-based support), as suitable.
This requires an initial face-to-face consultation lasting at least 30 minutes, delivered by a physician or other qualified health professional, and the first 30 minutes provided by a physician or another qualified healthcare professional, each month. (When employing G3002, the minimum of 30 minutes should be met or exceeded.)
G3003: Any additional 15-minute increment of chronic pain management and treatment conducted by a physician or other qualified healthcare professional, per month (to be listed separately in conjunction with the G3002 code). (When utilizing G3003, the minimum of 15 minutes should be met or exceeded.)
CMS emphasizes several crucial aspects through the Alliance to Advance Comprehensive Integrative Pain Management:
- CMS clarifies that while all elements of the code bundle are to be offered by clinicians, not every aspect may be applicable to every patient.
- Although an initial in-person meeting is mandatory for the billability of CPM codes, CMS does not require in-person care for every subsequent visit, be it monthly or at other intervals.
- While CMS mandates the utilization of a validated pain scale for Medical billing providers, it does not enforce the use of a specific pain assessment measure due to the intricate nature of pain experiences, varying among individuals, and the diverse approach needed for effective treatment.
Extended Telehealth Codes Throughout 2023
CMS is upholding a multitude of services that have temporarily transitioned into telehealth offerings for the duration of the Public Health Emergency (PHE) until the conclusion of 2023.
Over 40 codes on the Medicare Telehealth Services List are slated to shift their status to “Available up Through December 31, 2023.” CMS is prolonging the timeframe for which these services are temporarily incorporated within the Medicare Telehealth Services List during the PHE. The 2022 Consolidated Appropriations Act (CAA) introduced a 151-day extension to Medicare telehealth flexibilities, including the allowance of telehealth services in any geographical location and originating site setting, encompassing the beneficiary’s residence. This extension also permits the provision of particular services through audio-only telecommunications systems and extends telehealth privileges to physical therapists, occupational therapists, speech-language pathologists, and audiologists. Moreover, the CAA extends the requirement for in-person visits for mental health services delivered via telehealth to 152 days after the conclusion of the PHE.
In 2023, CMS continues to endorse the billing of telehealth claims with the same place of service indicator that would have been utilized for an in-person visit. These claims necessitate the use of modifier-95 to signify that the services were conducted and provided as telehealth offerings through the later of the conclusion of CY 2023 or the termination of the year in which the PHE concludes.