New Telemedicine CPT Codes (98000-98016)

[FlowRate]

Hi All,

For those not aware, the latest CPT release included a number of new codes for telemedicine services. Medicare Telehealth Policies Extended and New CPT Codes for 2025

CMS is not reimbursing for those codes this year and is recommending continuing to use established E/M codes. (Although I saw another article that said this may vary by region?)

It looks like some insurers may start adopting the new codes: WSI Adopting New Telehealth CPT Codes | North Dakota Workforce Safety & Insurance

Is anyone else navigating implementing these new codes?

Also I wonder if, after widespread adoption, it may lead to net reduction in psychiatry reimbursement. Our field does a lot of telehealth work and it's hard to imagine these codes reimbursing the same or more than their office-based E/M equivalents. Any predictions? Anyone started negotiating rates for these yet? Also, anyone have confirmation whether these can be billed with psychotherapy add-on codes?

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[Sushirolls]

Solution to a problem that didn't exist.
We don't need new codes.
The service hasn't changed.
GT modifier works just fine.

If any insurance company forces me to use new codes AND lowers reimbursement, I'm dropping them, or will tell patients their insurance devalues telemedicine and they must come to the office.

 

[Stagg737]

This is weird, especially since it's insurance reimbursing these new codes first while CMS stays with the "normal" E/M codes. Looks like wRVUs will be the same as the equivalent E/M (ie 9921x) code, so shouldn't affect those being paid based on wRVUs like myself.

I could certainly see this as an intentional barrier to telepsychiatry and hamper some of the larger companies/pill mills from making so much with 10 minute med checks and billing everything 99214. I do think this will eventually affect legit telepsychiatrists in PP though.

One interesting point is the addition of "Audio only" billing for patients who refuse or can't use video. wRVUs are only slightly lower than for the E/M equivalent (1.75 vs 1.92 for moderate complexity f/up). I predict this is going to either get dropped or amended seriously if we see larger companies suddenly just using phone calls to bill 8+ appointments per hour for basic med refills.

 

[FlowRate]

I predict this is going to either get dropped or amended seriously if we see larger companies suddenly just using phone calls to bill 8+ appointments per hour for basic med refills.

In another article I read, they emphasized that audio-only codes, even if billed on MDM, have to include at least 11 minutes of discussion.

Which is actually a lot for like a 3-6 month check-in on a totally stable patient on just an SSRI who's calling in from work. Yes, said patient should probably go back to PCP at that point, but adds some pressure to make random conversation with the pt to hit a time breakpoint.

 

[Merovinge]

In another article I read, they emphasized that audio-only codes, even if billed on MDM, have to include at least 11 minutes of discussion.

Which is actually a lot for like a 3-6 month check-in on a totally stable patient on just an SSRI who's calling in from work. Yes, said patient should probably go back to PCP at that point, but adds some pressure to make random conversation with the pt to hit a time breakpoint.

That seems like a feature, not a bug, to me. We do not need to financially incentivize a doc to sit in a phone bank having a person tee-up 2 minute conversations and have the next 3 patched in so they can do bill 30 patients/hour...

 

[FlowRate]

That seems like a feature, not a bug, to me. We do not need to financially incentivize a doc to sit in a phone bank having a person tee-up 2 minute conversations and have the next 3 patched in so they can do bill 30 patients/hour...

I agree, just noting an unintended consequence of an otherwise appropriate policy. It's actually still probably an improvement (depending on how wRVU's end up getting assigned) vs. the prior telephone codes, anyway.

 

[Stagg737]

In another article I read, they emphasized that audio-only codes, even if billed on MDM, have to include at least 11 minutes of discussion.

Which is actually a lot for like a 3-6 month check-in on a totally stable patient on just an SSRI who's calling in from work. Yes, said patient should probably go back to PCP at that point, but adds some pressure to make random conversation with the pt to hit a time breakpoint.

Well that certainly dis-incentivizes audio-only calls. No reason to do audio only unless a patient truly can't do it when you can do a video call in 5 minutes and still bill full MDM. Also seems like a way for insurance companies to just refuse to reimburse any appointment less than 11 minutes, but idk.

 

[aim-agm]

For VA folks, it looks like CPRS (at least at my facility) has been updated to include these new codes and you can't enter 9944x codes anymore.

 

[Psychferlyfe3000]

Are the criteria for these codes not virtually identical to the current codes used? Where are people seeing the differences?

 

[psydocc]

Are the criteria for these codes not virtually identical to the current codes used? Where are people seeing the differences?

The difference will come in 2 years when reimbursement for these new codes gets slashed substantially. There is no other reason to create entirely new codes.

 

[Sushirolls]

^Nailed it.

 

[FlowRate]

The difference will come in 2 years when reimbursement for these new codes gets slashed substantially. There is no other reason to create entirely new codes.

I could see someone at Medicare thinking it's "fair" to reimburse less for the practice expense component, channeling the 100% telehealth companies, totally screwing all of the people who offer patients a choice of telehealth or office appointments any/most days of the week.

 

[FlowRate]

Anyone involved with APA or know people involved with APA? I'm starting to see guidance that +90833 can't be billed with the new video codes. Seems like we need some organized advocacy...

 

[Merovinge]

Anyone involved with APA or know people involved with APA? I'm starting to see guidance that +90833 can't be billed with the new video codes. Seems like we need some organized advocacy...

Sir, this is a Wendy's....

 

[FlowRate]

Sir, this is a Wendy's....

I pinged our state psych society president, figured other people might be able help get things moving...

 

[Merovinge]

I pinged our state psych society president, figured other people might be able help get things moving...

Apologize for my cynicism, have you seen effective lobbying efforts by the APA?

 

[FlowRate]

Apologize for my cynicism, have you seen effective lobbying efforts by the APA?

Fatalism + bystander effect is a surefire way to see nothing happen. And given this is more of an advocating with the AMA and insurers thing than advocating with congress thing, I think there's more room for effect. Already got a reply that this is being worked on w/r/t advocating that insurers continue to use/allow E/M codes for telehealth, in line with current state and parity, rather than transitioning to the new codes. This sort of lobbying/advocacy work is rarely visible publicly.

 

[Stagg737]

I pinged our state psych society president, figured other people might be able help get things moving...

Please report back with response, aka chocolate vs vanilla frosty.

ETA: Dang, wish and I shall receive I guess, lol. Still waiting to hear what flavor frosty you got though...

 

[FlowRate]

Please report back with response, aka chocolate vs vanilla frosty.

ETA: Dang, wish and I shall receive I guess, lol. Still waiting to hear what flavor frosty you got though...

The true Wendy's faithful know that there is only one Frosty and it is, by definition, chocolate.

 

[psydocc]

Anyone involved with APA or know people involved with APA? I'm starting to see guidance that +90833 can't be billed with the new video codes. Seems like we need some organized advocacy...

Could you share where this guidance is coming from? If these new telehealth codes end up reimbursing lower than the normal rate and forbid the 90833 add on, well that would be a fantastic way to make telepsychiatry financially unfeasible unless it's an overbooked pill mill.

 

[FlowRate]

Could you share where this guidance is coming from? If these new telehealth codes end up reimbursing lower than the normal rate and forbid the 90833 add on, well that would be a fantastic way to make telepsychiatry financially unfeasible unless it's an overbooked pill mill.

Two sources: It was guidance another organization had sent some of their docs that one of my colleagues knows. Also our internal billing team was uncertain/hadn't clarified yet/indicated more against than for. The reply we got from APA was that various payors will have their own take and may allow the psychotherapy add-on with the new telehealth codes but that APA is advocating for current state (since it reimburses better.)