For Medicare patients in observation, the consulting physician uses new and established patient visit codes. Only the admitting physician can use initial and subsequent observation codes for Medicare patients in observation. Some commercial payers still recognize outpatient consults, and allow a consulting physician to bill subsequent observation codes. But Medicare does not.  Questions about what […]

The AMA released a CPT®  code for use in non-facility settings for the expense related to supplies, equipment and staff time and activities for visits performed during the PHE due to respiratory-transmitted infectious disease, effective Sept 8, 2020 Some commercial payers are recognizing the paying a small amount for this code. • 99072 Additional supplies, […]

Question: Can we code TCM and 99214 together? Answer: No, not if you mean on the same calendar date. On the day of the E/M service that is related to the TCM/discharge, use code 99495 or 99496. These TCM codes include the value of the first E/M service performed after the discharge. You don’t bill […]

This post discusses Medicare changes at the START of the PHE.  It is for HISTORICAL REFERENCE ONLY.  Some codes in this post have since been deleted.  This note added 2/11/2025 CMS issued multiple waivers and two interim final rules to support health care organizations and patients during the public health emergency in spring 2020 Medicare […]

**This content has moved*** See our primary telehealth article for the latest telehealth coding updates.

Many payers and practices use the broad term telehealth to describe services that are not done face-to-face with a patient CMs describes telehealth services as non-face-to-face services that are on its telehealth list During the public health emergency, CMS eased the rules related to telehealth The flexibilities remain in effect for RHCs and FQHCs for […]

The 2025 Physician Fee Schedule Final Rule, released in Nov. 2024 continues to allow RHCs and FHQCs to perform telehealth through all of 2025.  RHC and FQHC Update In April, 2020  CMS released guidance about paying for telehealth services in Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs). These payments were authorized by […]

Question: Why and when should we use modifier CS? Answer: Use modifier CS on visits related to testing for COVID-19. Modifier CS: cost sharing waiver for COVID-19 testing When you do, Medicare and private insurers will pay 100% of the claim, without any patient due cost sharing. The two laws that were passed require Medicare […]

This post discusses Medicare changes at the START of the PHE.  It is for HISTORICAL REFERENCE ONLY. Effective retroactively to 3/18/20, there is no cost sharing allowed for COVID-19 testing or for the evaluation visits related to the testing Medicare instructs us to use modifier CS on the visits and tests, and to contact your […]

Telephone codes 99441–99443 were deleted from the 2025 CPT book. This post discusses Medicare changes at the START of the PHE.  It is for HISTORICAL REFERENCE ONLY.  Some codes in this post have since been deleted.  This note added 2/17/2025 CMS rules for phone calls has changed during the course of the pandemic.  Prior to the […]

Recorded July 15th, 2020

The coding and reimbursement rules for telehealth changed fast in March. Congress passed a law relaxing certain telemedicine restrictions during the period of a government state of emergency. This webinar will describe the new telehealth Medicare rules. Join us to learn about CPT coding for telehealth, diagnosis coding, and the type of communication that can be used for telehealth services.

Question We have students from a nurse practitioner program rotate through our practice. Can we use their notes the same way as medical student notes? Answer As of January 1, 2020, yes. The quotes below are excerpts from the 2020 Physician Fee Schedule Final Rule. Here’s the cliff notes: A physician, APRN or PA can […]

CMS developed this HCPCS code to report additional non-face-to-face staff time performing non-complex care management services Use this code only with CPT code 99490 This 20-minute time-based code may only be reported twice in a calendar month The existing code for clinical staff non-complex chronic care management is CPT code 99490,  defined as 20 minutes […]

Question: Do we need to have a physician in the office when our clinical staff gives flu shots? Answer: No. CMS allows flu shots to be given without a physician order and without physician supervision. From MLN Matters: Remember the following regarding the influenza vaccine:  Medicare allows one influenza (flu) vaccination per year; Medicare does […]

Question: In order to bill a TCM visit, is anything else needed besides the phone call and E/M visit? (Codes 99495 and 99496) Answer: Yes, I’m so glad you asked. Let’s go to CPT®. “TCM is comprised of one face-to-face visit within the specified timeframes, in combination with non-face-to- face services that may be performed […]

Recorded October 31, 2019 This content is no longer current Let’s compare the current medical decision-making rules with the CPT changed rules for 2021 for codes 99202—99215. The existing rules and the revised rules are similar enough to be confusing, and different enough to require practice. For October’s webinar, we will look at the MDM […]

Question: Can we charge an E/M service when we do a scheduled endoscopy to account for the cost of nursing staff, supplies, pre- and post- care of the patient in the suite? We use place of service office, and I know we can’t charge a facility fee. Many of our commercial payers pay the same […]

Medical Decision Making: selecting the correct level of service for codes 99202—99215:  E/M codes 99202—99215  have a changed definition of MDM The new MDM chart is similar to the current table of risk, but with significant changes, particularly in data Finally! Definitions of key terms in MDM The AMA is working on changing the documentation […]

It’s here! New definitions for codes 99202–99215 Clinicians can select new and established patient visit based on time or medical decision making (MDM) New guidelines for using time for 99202—99215, and revised definitions for MDM The American Medical Association (AMA) CPT® panel changed the definitions, and CMS is in agreement with these. The changes below […]