Telehealth CPT Codes in 2022

Telehealth CPT Codes

Find the Most Important Telehealth CPT Codes

Every year, the American Medical Association releases an updated list of Current Procedural Terminology (CPT) codes. These codes form a universal language for providers to break down the cost of treatment. To do this, they group services into categories that streamline a clinic’s reporting and billing. And remote practices are no different thanks to their own set of telehealth CPT codes.

The past few years have seen telehealth services become more and more popular. If that wasn’t enough, 2022 looks like another critical year for virtual healthcare. And it looks like the American Medical Association has taken notice. Because in their updates codes for 2022, new technology plays into 43% of code changes [1].

For fast reimbursement, clinics need to stay up to date on telehealth CPT codes. Thankfully, Beam is here to help. We’ve outlined some of the most relevant codes for remote providers. With these CPT changes in mind, your telehealth practice will stay on top of billing throughout the year.

Telehealth CPT Codes for Therapeutic Remote Monitoring

In previous years, clinics lumped telehealth CPT codes with outpatient evaluation and management services (E/M). While an overlap still exists, the AMA has made some notable changes. In particular, remote patient monitoring requires its own set of codes [2]. As a result, remote practices use these codes to bill for therapeutic remote monitoring:

98975Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment
98976device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days
98977device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days
98980Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes
98981each additional 20 minutes (listed separately in addition to code for primary procedure)

Pathology and Laboratory Services

Telehealth changes the way clinics perform services. At a walk-in, reviewing test results and pathologies overlaps with face-to-face checkups. But virtual platforms let patients share this information via email or at a different time from their consult. Telehealth CPT codes had to reflect this change.

With this in mind, pathology and laboratory services saw an expansion [3]. Now, four new codes better differentiate between consults and medical decision-making.

80503 Pathology clinical consultation; for a clinical problem, with limited review of patient’s history and medical records and straightforward medical decision making. When using time for code selection, 5-20 minutes of total time is spent on the date of the consultation.
80504For a moderately complex clinical problem, with review of patient’s history and medical records and moderate level of medical decision making. When using time for code selection, 21-40 minutes of total time is spent on the date of the consultation.
80505For a highly complex clinical problem, with comprehensive review of patient’s history and medical records and high level of medical decision making. When using time for code selection, 41-60 minutes of total time is spent on the date of the consultation.
80506Prolonged service, each additional 30 minutes (List separately in addition to code for primary procedure).

Principle Care Services

As remote principle care gets more popular, telehealth CPT codes needed a change. For patients with one complex or chronic condition, virtual checkups are essential [4]. So, the American Medical Association introduced changes to better align with Medicare guidelines. Clinics focusing on the elderly and long-term disease management will get the most out of these codes.

99424Principal care management services, for a single high-risk disease with the following required elements:
• One complex chronic condition expected to last at least 3 months, and that places the patient at significant of hospitalization, acute exacerbation decompensation, functional decline or death,
• Condition requires development, monitoring or revision of the disease specific care plan,
• Condition requires frequent adjustments in medication regimen and/or regimen and/or the management of the condition is usually complex due to comorbidities
• Ongoing communication and care coordination between relevant practitioners furnishing care; First 30 minutes provided personally by a physician or other qualified health care professional; per calendar month.
99425Each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure).
99426Principal care management services, for a single high-risk disease with the same required elements as code 99424 (see previous slide). First 30 minutes of clinical staff time directed by a physician or other qualified health care professional; per calendar month.
99427each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional; per calendar month (List separately in addition to code for primary procedure).

Knowing the right telehealth CPT codes can save you clinic time and ensure fast billing. On top of that, Beam will go a step further to empower providers. We offer a free year of access to our all-in-one platform to qualifying mental health clinics. Click here to learn more.

Sources:

[1] https://www.fiercehealthcare.com/practices/ama-releases-more-than-400-cpt-code-changes-for-2022-to-align-new-tech-services

[2]https://www.asha.org/practice/reimbursement/coding/new_codes_aud/#:~:text=98975%3A%20Use%20to%20report%20the,U.S.%20Food%20and%20Drug%20Administration.

[3] https://vachettepathology.com/2022-cpt-updates-for-pathology-consults/

[4] https://www.ama-assn.org/press-center/press-releases/ama-releases-2022-cpt-code-set

Leave a comment

Your email address will not be published. Required fields are marked *