Reimbursements

CY 2016 Medicare Telehealth Reimbursements

HCPCS codes G0425–G0427

Telehealth consultations, emergency department or initial inpatient

HCPCS codes G0406–G0408

Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs

CPT codes 99201–99215

Office or other outpatient visits

CPT codes 99231–99233

Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days

CPT codes 99307–99310

Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days

HCPCS codes G0420 and G0421

Individual and group kidney disease education services

HCPCS codes G0108 and G0109

Individual and group diabetes self-management training services, with a minimum of 1 hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training

CPT codes 96150–96154

Individual and group health and behavior assessment and intervention

CPT codes 90832–90834 and 90836–90838

Individual psychotherapy

HCPCS code G0459

Telehealth Pharmacologic Management

CPT codes 90791 and 90792

Psychiatric diagnostic interview examination

CPT codes 90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961

End-Stage Renal Disease (ESRD)-related services included in the monthly capitation payment

HCPCS code G0270 and CPT codes 97802–97804

Individual and group medical nutrition therapy

CPT code 96116

Neurobehavioral status examination

HCPCS codes G0436 and G0437 and CPT codes 99406 and 99407

Smoking cessation services

HCPCS codes G0396 and G0397

Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services

HCPCS code G0442

Annual alcohol misuse screening, 15 minutes

HCPCS code G0443

Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes

HCPCS code G0444

Annual depression screening, 15 minutes

HCPCS code G0445

High-intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes

HCPCS code G0446

Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes

HCPCS code G0447

Face-to-face behavioral counseling for obesity, 15 minutes

CPT code 99495

Transitional care management services with moderate medical decision complexity (face-to-face visit within 14 days of discharge)

CPT code 99496

Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge)

CPT codes 90845

Psychoanalysis (effective for services furnished on and after January 1, 2015)

CPT code 90846

Family psychotherapy (without the patient present) (effective for services furnished on and after January 1, 2015)

CPT code 90847

Family psychotherapy (conjoint psychotherapy) (with patient present) (effective for services furnished on and after January 1, 2015)

CPT code 99354

Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (effective for services furnished on and after January 1, 2015)

CPT code 99355

Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (effective for services furnished on and after January 1, 2015)

HCPCS code G0438

Annual Wellness Visit, includes a personalized prevention plan of service (PPPS) first visit (effective for services furnished on and after January 1, 2015

HCPCS code G0439

Annual Wellness Visit, includes a personalized prevention plan of service (PPPS) subsequent visit (effective for services furnished on and after January 1, 2015)

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