The 2023 telehealth service codes physicians need to know

Question: Can you please give us the new telehealth services codes for 2023?

A: Medicare Telehealth Services for 2023, Centers for Medicare and Medicaid Services (CMS) is adding new Healthcare Common Procedure Coding System (HCPCS) codes to the list of Medicare telehealth services, specifically the following HCPCS codes.

Prolonged Service Codes

G0316: Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services)

G0317: Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99306, 99310 for nursing facility evaluation and management services)

G0318: Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99345, 99350 for home or residence evaluation and management services)

For each of these codes, be mindful of the applicable place of service – inpatient/observation, nursing facility or home/residence.The original codes for these services must have been chosen based on time, instead of medical decision making, and these codes should not be billed for any time less than 15 minutes.

Chronic pain management and treatment bundles

G3002: Chronic pain management and treatment, monthly bundle including, diagnosis;

• administration of a validated pain rating scale or tool;
• the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes;
• overall treatment management;
• facilitation and coordination of any necessary behavioral health treatment;
• medication management;
• facilitation and coordination of any necessary behavioral health treatment;
• pain and health literacy counseling;
• any necessary chronic pain-related crisis care; and/or,
• ongoing communication and care coordination between relevant practitioners furnishing care (e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care), as appropriate.

Required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (When using G3002, 30 minutes must be met or exceeded.)

G3003: Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month (list separately in addition to code for G3002). (When using G3003, 15 minutes must be met or exceeded.)

Key CMS points, per the Alliance to Advance Comprehensive Integrative Pain Management, include:

1. CMS specifically states, “We are clarifying that clinicians will be required to furnish all appropriate elements of the code bundle, but also clarifying that we do not expect that all elements of the code bundle will be appropriate for every patient.”
2. While CMS will be requiring an initial face-to-face visit in order for the CPM codes to be billable, they will not be requiring in-person care for each subsequent visit, whether these be monthly or at some other time.
3. While CMS will be requiring that billing providers utilize a validated pain scale, it will not be requiring the use of any single pain assessment measure, “because no particular tool or tool set can assess the complex nature of the experience of pain across all individuals, nor appropriately guide its treatment.”

Additional Telehealth Codes Continued through 2023

CMS is retaining many services that are temporarily available as telehealth services for the duration of the Public Health Emergency (PHE) through 2023.

The status of more than 40 codes on the Medicare Telehealth Services List will change to, “Available up Through December 31, 2023.” CMS is extending the duration of time that services are temporarily included on the Medicare Telehealth Services List during the PHE. CMS is implementing the 151-day extensions of Medicare telehealth flexibilities in the 2022 Consolidated Appropriations Act (CAA), including allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home. It also allows certain services to be furnished via audio-only telecommunications systems, and allows physical therapists, occupational therapists, speech-language pathologists, and audiologists to furnish telehealth services. The CAA also delays the in-person visit requirements for mental health services furnished via telehealth until 152 days after the end of the PHE.

For 2023, CMS continues that telehealth claims may continue to be billed with the place of service indicator of what it would have been had the service been billed for an in-person visit. These claims will require the modifier-95 to identify them as services performed and provided as telehealth services through the later of the end of CY 2023 or end of the year in which the PHE ends.

The list of codes that are added to the telehealth services list can be found at: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

Renee Dowling is a compliance auditor at Sansum Clinic, LLC, in Santa Barbara, California.