Telehealth billing coding

[randomdoc1]

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Does anyone know how to utilize these codes and can 90833 be added to the new E&M codes?

Effective January 1, 2025:

• ForwardHealth covers new telehealth CPT codes 98000–98015 for E/M services. Once the systems updates are complete, ForwardHealth will automatically process any suspended claims. No other action is required.
• The AMA end-dated E/M telehealth CPT codes 99441, 99442, and 99443 December 31, 2024.
• Per AMA official guidance:
  • CPT codes 99202–99205 and 99212–99215 are no longer used with telehealth place of service (POS) codes 02 (Telehealth Provided Other Than in Patient's Home) and 10 (Telehealth Provided in Patient's Home).
  • POS codes 02 and 10 for 99202–99205 and 99212–99215 were end-dated December 31, 2024. If a claim was previously denied, providers should refer to the new E/M telehealth CPT codes 98000–98015.
• ForwardHealth has updated coverage policy for office or outpatient E/M services. This mirrors official AMA changes to Appendix P of the 2025 CPT codebook (with CPT codes that may be used for synchronous real-time interactive audio-visual telemedicine services).

 

[calvnandhobbs68]

1) Am not having to use these codes yet but have heard rumblings in the facebook groups about this...especially that some insurers are reimbursing less for these codes.

2) Seems to be unclear if 90833 can be used with these codes but people are reporting that 90833s are getting rejected when added with these codes.

3) All my patients will be coming in person if either of these things becomes the case for me.

 

[randomdoc1]

1) Am not having to use these codes yet but have heard rumblings in the facebook groups about this...especially that some insurers are reimbursing less for these codes.

2) Seems to be unclear if 90833 can be used with these codes but people are reporting that 90833s are getting rejected when added with these codes.

3) All my patients will be coming in person if either of these things becomes the case for me.

That's what I figured too. Safer to start bringing folks in person. I've seen the United Medicaid product start buckling down on this and tbd what other insurances do.

 

[Atreides]

Looks like Montana just started doing this (I don't see clinical patients there but am on an FB group for Montana clinicians). That doesn't bode well, I was hoping telehealth parity laws would preclude these codes from being implemented in telehealth parity states. I saw on one of the psychiatry FB groups that someone's rate got slashed 75% for 30 minute follow ups because therapy add-on codes got rejected and the reimbursement was quite a bit less than a 99214.

 

[Stagg737]

Couple things for this from a quick review:
1. From what I can find CMS is not accepting the new codes and will continue to use the traditional 992xx codes
2. Total RVUs are decreasing, but wRVUs are remaining the same
3. It appears that at least in some states you CAN add on 90833 to the 9800x codes and insurances will reimburse for this (example for BCBS in MI: CPT code changes)

So seems like CMS patient can continue to be seen via telehealth universally and the 90833 add-on is still valid. For private/plus plans, there is going to be more variability. For those of us who are employed or paid based on straight wRVUs this may not matter much unless the employers decide to "adjust" how we're credited wRVUs. For those in private practice who also collect total RVUs it will make a difference as total RVUs for the 9800x codes are a bit lower (New 2025 Telehealth CPT Codes - Society for Maternal-Fetal Medicine). Also seems like an excuse to not accept psychotherapy add-on codes for telehealth, so just another way for private payers to try and minimize reimbursements.

 

[randomdoc1]

Couple things for this from a quick review:
1. From what I can find CMS is not accepting the new codes and will continue to use the traditional 992xx codes
2. Total RVUs are decreasing, but wRVUs are remaining the same
3. It appears that at least in some states you CAN add on 90833 to the 9800x codes and insurances will reimburse for this (example for BCBS in MI: CPT code changes)

So seems like CMS patient can continue to be seen via telehealth universally and the 90833 add-on is still valid. For private/plus plans, there is going to be more variability. For those of us who are employed or paid based on straight wRVUs this may not matter much unless the employers decide to "adjust" how we're credited wRVUs. For those in private practice who also collect total RVUs it will make a difference as total RVUs for the 9800x codes are a bit lower (New 2025 Telehealth CPT Codes - Society for Maternal-Fetal Medicine). Also seems like an excuse to not accept psychotherapy add-on codes for telehealth, so just another way for private payers to try and minimize reimbursements.

so so helpful!! I think we will be ok. It's such a hassle to readjust. But I guess this to be expected since CPT coding evolves regularly anyways. The uncertainty is what gets me. I've been having patients come in office anyways for more ideal care. And always been very judicious with telehealth. So I'm not as affected as those more reliant on telehealth. Plus my practice is psychotherapy heavy, and the purely psychotherapy codes have not been affected.

 

[psydocc]

3. It appears that at least in some states you CAN add on 90833 to the 9800x codes and insurances will reimburse for this (example for BCBS in MI: CPT code changes)

On average, the new telemedicine E/M codes reimburse about 25% less than their in-office counterparts. These rates are determined by the insurance payer — not Headway — and reflect an industry-wide shift in how telehealth services are categorized and paid.

So a telehealth 98006 + 90833 would be reimbursed about the same as an in person 99214 without therapy add on. This effectively makes telehealth therapy time worthless.

 

[comp1]

This is good. I'm hopeful this trickles down to salaries. It's impossible to recruit anybody for in person nowadays and it's not unreasonable as there certainly is a cost involved with doing in person work that should be reflected.

 

[Atreides]

This is good. I'm hopeful this trickles down to salaries. It's impossible to recruit anybody for in person nowadays and it's not unreasonable as there certainly is a cost involved with doing in person work that should be reflected.

It won't, that ship has sailed. It's just going to disincentivize psychiatrists from taking insurance, something that's become much more common ever since the psychotherapy add codes were introduced.

I can tell you for sure, I would drop all my insurances before I gave up WFH.

 

[randomdoc1]

I really don't see this as a bad thing. There is a qualitative difference in the two services. In person has costs like desk staff, rent, furniture, janitorial work, premise liability, commuting, etc. The physician can also see the patient head to toe and do an actual physical. The patient end of the day should be given the level of care most appropriate to them and it be priced appropriately (it keeps care affordable, sustainable, accessible). I may get some flames when saying this, but a lot of people have really abused remote work (and this ruins it for the folks who were respectful and judicious with it). I think telehealth can be used to promote access to care such as a patient with a busy work schedule, living in a rural area, transportation limitations, etc. But it should not used to appease someone's desire for convenience at the cost of patient quality of care. It's a careful balancing act. Some may be familiar with my prior threads of a provider having abused telehealth at my practice. I required the provider to bring patients back in office at least once a year for a full MSE and check on labs. They didn't give a rap that metabolic labs were overdue (by nearly 3 years!!) and some developed entrenched tardive dyskinesia. All they cared about was staying in the comfort of their home and they were well aware of the risk they were exposing patients to. Such a "service" does not deserve the full reimbursement. Or at least in some of those encounters, any reimbursement in my opinion. Don't get me wrong, there is good telepsychiatry out there, but there's a lot of people who did an awful job, exploited it, and did not give a care. This is one of the consequences.

Thing is, telehealth was available well before COVID. Hence POS 02. It did reimburse at the same as in person services. I suspect one of the reasons why is because it was being used appropriately. It's my speculation but if people stayed judicious with telehealth usage, I don't think these changes would be as dramatic. If the level of care was still just as good as in person and promoting the same outcomes and ultimately decreasing complications and long term healthcare costs--the economic incentive would be to promote telehealth without the pay cut. But, ship has sailed. Here we are now....

 

[Orgone]

I guess I'd be willing to take some financial hit if it also meant putting an end to the sheisty telepsych pill-mill companies.

 

[Attending1985]

This is sad to read. I would say about 50% of my practice is telehealth and patients and myself really appreciate that option. I’ve appreciated it as a patient. I’m employed but if payment goes down I can imagine it being discouraged.

 

[Stagg737]

On average, the new telemedicine E/M codes reimburse about 25% less than their in-office counterparts. These rates are determined by the insurance payer — not Headway — and reflect an industry-wide shift in how telehealth services are categorized and paid.

So a telehealth 98006 + 90833 would be reimbursed about the same as an in person 99214 without therapy add on. This effectively makes telehealth therapy time worthless.

I actually think it's the opposite. It makes telehealth therapy time more valuable because without that 90833 add-on you're taking a significant pay cut as opposed to just seeing someone in person for med management. It makes those 10 minute med management appointments by those big telehealth companies using NPs worth less. If you take the time to practice good care with psychotherapy then that financial hit is lessened.

I may get some flames when saying this, but a lot of people have really abused remote work (and this ruins it for the folks who were respectful and judicious with it). I think telehealth can be used to promote access to care such as a patient with a busy work schedule, living in a rural area, transportation limitations, etc. But it should not used to appease someone's desire for convenience at the cost of patient quality of care.

I guess I'd be willing to take some financial hit if it also meant putting an end to the sheisty telepsych pill-mill companies.

I think that anyone who thought telehealth was going to be "the new norm" without limits were being naive. As soon as the big telehealth companies with their armies of NPs doing 10 minute med checks and doling out benzos and stimmies like a candy shop arose I knew there'd eventually be some major backlash. In our society, change is implemented with a sledgehammer, not a scalpel, and this was the inevitable response to those companies trying to cash in on the new frontier.

It's unfortunate that this is occurring and that it will hit legitimate PP's who have integrated telehealth into good practice as hard as every crappy telepsych company, but I don't think anyone should be surprised by this.

 

[psydocc]

I actually think it's the opposite. It makes telehealth therapy time more valuable because without that 90833 add-on you're taking a significant pay cut as opposed to just seeing someone in person for med management. It makes those 10 minute med management appointments by those big telehealth companies using NPs worth less. If you take the time to practice good care with psychotherapy then that financial hit is lessened.

A lot of the big telehealth companies actually use 90833 add on codes and are thus limited to 2-3 patients per hour. If they continued to do that then they would experience a 25% (or more) revenue cut. I think a cut like this will encourage more of them to ditch the 90833 altogether and start doing the 5-10 minute med checks instead.

 

[Stagg737]

A lot of the big telehealth companies actually use 90833 add on codes and are thus limited to 2-3 patients per hour. If they continued to do that then they would experience a 25% revenue cut. I think a cut like this will encourage more of them to ditch the 90833 altogether and start doing the 5-10 minute med checks instead.

Probably, not uncommon for the solution to just worsen the problem. We’re also looking at this from a purely psych perspective, but other companies that for telehealth like HIMS and HERS already do this for primary appointments. I doubt there was much thought about how therapy add ons were affected other than insurances taking advantage of the change and saying they just won’t reimburse those add ons.

 

[allantois]

local blue cross has been processing all telehealth claims under these rules for past 4 months or so. They reimburse a 98005 (an equivalent of 99213) around $40-50 and 98006 (99214) around $60-70.. I have mostly stopped seeing these patients via telehealth

 

[calvnandhobbs68]

local blue cross has been processing all telehealth claims under these rules for past 4 months or so. They reimburse a 98005 (an equivalent of 99213) around $40-50 and 98006 (99214) around $60-70.. I have mostly stopped seeing these patients via telehealth

what's that relative to a 99213/99214? That'd be like 50% less of what BCBS reimburses for 99213/99214 around here....yeah no way man.

But yeah if they start doing that here it'll really suck for like the people who have to drive 1.5 hours round trip to get to me or the college kids who are in state an hour away....will have to make some decisions. Hopefully not.

 

[allantois]

what's that relative to a 99213/99214? That'd be like 50% less of what BCBS reimburses for 99213/99214 around here....yeah no way man.

But yeah if they start doing that here it'll really suck for like the people who have to drive 1.5 hours round trip to get to me or the college kids who are in state an hour away....will have to make some decisions. Hopefully not.

It’s around 50% less

 

[randomdoc1]

It’s around 50% less

Interesting. I ran the fee schedule tool for my local BCBS and the estimate I got was "50% of the charge". So If I put $600, my 99214 payout should be $300, an upgrade from the $124.32? Now I'm so curious.

United says to bill as usual and use the old codes:

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Replacement-Codes-Policy.pdf

I'm surprised, they are always looking at a chance to slash reimbursement.

 

[brosa]

It won't, that ship has sailed. It's just going to disincentivize psychiatrists from taking insurance, something that's become much more common ever since the psychotherapy add codes were introduced.

I can tell you for sure, I would drop all my insurances before I gave up WFH.

Can you, tho? Not trying to be passive aggressive, but I have a hard time patients dropping $400 or so to be seen remotely when they can just open another website and get a remote psychiatrist that will take their insurance. Someone else here at SDN couldn't fill a remote panel with cash only patients. I often see talks about cash only, but haven't met anyone in real life going that route.

 

[randomdoc1]

Can you, tho? Not trying to be passive aggressive, but I have a hard time patients dropping $400 or so to be seen remotely when they can just open another website and get a remote psychiatrist that will take their insurance. Someone else here at SDN couldn't fill a remote panel with cash only patients. I often see talks about cash only, but haven't met anyone in real life going that route.

I have never seen anyone be able to live off a cash only practice. I have seen people do self pay practices and supplement with moonlighting though. Far more often than not, I see cash practices bombarding my office begging for referrals. Not a flattering look and very telling about the market. Also, cash based patient populations statistically are higher odds of:
-drug seeking
-primarily looking for some sort of paperwork (especially for something major like trying to get an expert witness to win a lawsuit)
-high acuity/severity
-fired from every other clinic in the area

People willing to pay big are more likely to be looking for some sort of return on their investment. And it's not our amazing board certified pharmacology of SSRIs.

 

[calvnandhobbs68]

Kind of wish they made codes for people who have been seen in person at least once (so like could continue using 99213/99214 codes virtual if have been seen in person at least 1x) vs virtual only codes for patients who have never been seen in office. It would at least help to differentiate patients who are still in your area but prefer virtual or may be way better for them cause they have to drive hours to get to you.

 

[Atreides]

Can you, tho? Not trying to be passive aggressive, but I have a hard time patients dropping $400 or so to be seen remotely when they can just open another website and get a remote psychiatrist that will take their insurance. Someone else here at SDN couldn't fill a remote panel with cash only patients. I often see talks about cash only, but haven't met anyone in real life going that route.

Well, I've already toyed with the idea of dropping insurance completely; the main reason I haven't is that I want to grow my practice to be multi-physician and while I could fill my own panel with cash only, I highly doubt I could fill a group practice with cash only. I'd need to change my long-term plans and marketing/networking strategy but I'm perfectly happy to do that.

I'm not ruling out the possibility that I would need to start offering more in-person visits but if I had to do that, I would have zero incentive to take insurance.

 

[randomdoc1]

Well, I've already toyed with the idea of dropping insurance completely; the main reason I haven't is that I want to grow my practice to be multi-physician and while I could fill my own panel with cash only, I highly doubt I could fill a group practice with cash only. I'd need to change my long-term plans and marketing/networking strategy but I'm perfectly happy to do that.

I'm not ruling out the possibility that I would need to start offering more in-person visits but if I had to do that, I would have zero incentive to take insurance.

Take care ; ). I remember your earlier threads before you started and you've come a long way! It's very different working with other physicians as colleagues versus when you have a more senior role. You feel often like a punching bag for displaced insecurities and resentment. When in reality, you are on the same team and worked just as hard (likely harder by being a self starter) than colleagues. But, you are suddenly the big bad capitalist (trying to take advantage of us poor employees) and because you are "rich" people feel entitled to ask for outrageous pay (and hound you regularly, even monthly for raises--even if you were paying $350/hr) for giving zero work. Also, many people will not care much for the reputation of your practice, at least nowhere as much as you do. In reality, working and thinking of each other collectively is what promotes PP success and everyone's future. Commonly people are looking to get paid big today and they are looking far less at long term consequence--very short sighted. If I had to do it all over again...I'd grow much more slowly. With new hires, I no longer offer full time positions to physicians. And I do not hire people who just finished residency. Overwhelming majority, statistically speaking are just too naive, entitled, inexperienced -- life experience and emotional maturity is a pre-rec and also ingredients for an even better physician. The reputation of the practice comes first. I encourage physicians to work part time and keep part of another gig (when they work here), so people can compare and decide what they appreciate and learn what does not work for them. Otherwise it's like being trapped in 5 unhappy marriages all at once. A physician who is simultaneously employed elsewhere, gives you both the flexibility to titrate up or down what you both like and what you don't like. Don't underestimate how easily a poor performing psychiatrist can ruin the reputation (therefore SEO, referral stream, and financial security) of your brand--it is ironically from overconfidence and unrealistic views of how things stand in the market. It takes years of work to build up a place but from the historical experiences at my practice, less than 9 months to dismantle most of it (only takes one provider!). Kindness and humility is what propels us. btw, I've never hired NPs. These are all psychiatrists who work/worked at the practice. There's good providers out there. But just like establishing a healthy patient physician relationship, have healthy and firm boundaries and make expectations and realistic projections clear. I'm always on the lookout for people to join the team but learned to spend a lot more time lurking, gathering info and slowing hitting each small trigger.

 

[comp1]

W2 for life. Good luck to all of you...

 

[randomdoc1]

W2 for life. Good luck to all of you...

my practice is W2. If pay is affected strongly enough, hospital systems will also be changing their compensation structure. Good luck to all of US! bwahahahahaha

 

[comp1]

I seriously want hospital systems to change their compensation rates. People who battle commutes SHOULD be paid differently than people who don't. There's a huge difference.

 

[clausewitz2]

I seriously want hospital systems to change their compensation rates. People who battle commutes SHOULD be paid differently than people who don't. There's a huge difference.

The labor theory of value has unfortunately never really held true for very long anywhere.

 

[randomdoc1]

The labor theory of value has unfortunately never really held true for very long anywhere.

so much as to do with what people perceive as value....people as a general population are more willing to pay more over the year for starbucks than us. But, is what it is. I don't take it personally. And this is exactly why investing when picking individual stocks is so tough, human behavior is erratic. Indexing is the tried and true. Just always own shares of the top performing companies at any given time. Today's winners become tomorrow's losers and vice versa.

 

[Dr. M Toboggan]

I decided to take on a W-2 position while building my private practice during the first few years. The role is primarily virtual, with 30-minute follow-up visits. I requested a wRVU-based contract, as it seems some of the older docs there haven’t been billing 99213–99215 with 90833 add-ons.

I’m trying to figure out how that might affect my compensation before I finalize the contract, and whether I should push to move away from a wRVU model altogether.

 

[randomdoc1]

I decided to take on a W-2 position while building my private practice during the first few years. The role is primarily virtual, with 30-minute follow-up visits. I requested a wRVU-based contract, as it seems some of the older docs there haven’t been billing 99213–99215 with 90833 add-ons.

I’m trying to figure out how that might affect my compensation before I finalize the contract, and whether I should push to move away from a wRVU model altogether.

maybe ask them how the new codes would impact the compensation and see what options they can provide that are sustainable. Less reimbursement is less reimbursement and no matter how it's cut, employers can't keep a role open if it's too big a financial cost (there's running expenses to maintain and any company large or small...the relationship needs to be collaboratively beneficial or someone will eventually burn out...if the payings are too high on the provider's end, only a matter of time for the behavioral department to go bankrupt and shut down and that has indeed happened in major systems). I suspect something can be worked out. It looks like United Healthcare for the time being is not implementing the paycut. Maybe consider asking to only deal with certain insurances? Medicare also seems to not be implementing this for now. My local Medicaid is and some Blue Cross plans seem to be. But yes, for the Medicaid in my state, it's precisely about a 25% pay cut for 98006.

Some options could be, on your virtual days, only certain insurances and maybe one in person day. Then you could side step the paycut. A proposal like this would show you are being financially savvy for the best interest of all and ultimately yourself. Sidestepping the pay cut means better outcomes for all.

 

[Dr. M Toboggan]

maybe ask them how the new codes would impact the compensation and see what options they can provide that are sustainable. Less reimbursement is less reimbursement and no matter how it's cut, employers can't keep a role open if it's too big a financial cost (there's running expenses to maintain and any company large or small...the relationship needs to be collaboratively beneficial or someone will eventually burn out...if the payings are too high on the provider's end, only a matter of time for the behavioral department to go bankrupt and shut down and that has indeed happened in major systems). I suspect something can be worked out. It looks like United Healthcare for the time being is not implementing the paycut. Maybe consider asking to only deal with certain insurances? Medicare also seems to not be implementing this for now. My local Medicaid is and some Blue Cross plans seem to be. But yes, for the Medicaid in my state, it's precisely about a 25% pay cut for 98006.

Some options could be, on your virtual days, only certain insurances and maybe one in person day. Then you could side step the paycut. A proposal like this would show you are being financially savvy for the best interest of all and ultimately yourself. Sidestepping the pay cut means better outcomes for all.

Good advice. I am already planning to be onsite one day per week.

It sounds like some of the practices around me are still using the typical E/M codes + 90833 for virtual visits, so this must be very state-specific, so far.

 

[Dopamemes]

I seriously want hospital systems to change their compensation rates. People who battle commutes SHOULD be paid differently than people who don't. There's a huge difference.

I think you're on to something here. There should be additional compensation to account for the overhead of a physical office space. We should call it an office fee that insurance pays. Although you also have to compensate for the overhead of in-person staff, commute time, paying for electricity, etc, i.e. all the stuff that goes into a working facility. Let's call it a facility fee. We can have insurance pay that in addition to the reimbursement they pay us for our professional services.

This is good. I'm hopeful this trickles down to salaries. It's impossible to recruit anybody for in person nowadays and it's not unreasonable as there certainly is a cost involved with doing in person work that should be reflected.

Got to say (as someone who does see patients in-person at a W2 job), this mindset is endemic among physicians and is why we're always losing to midlevels. Rather than advocating for higher income for yourself, you're satisfied with other psychiatrists making less. The irony is that there literally exists a mechanism to compensate people more for in-person. Makes way more sense to make changes to get that to reflect in higher in-person salaries than to advocate for lower salaries. Especially because all you're doing is created a downward pressure on psychiatry income, which is then going to reflect in lower income for the in-person people too.

 

[calvnandhobbs68]

I think you're on to something here. There should be additional compensation to account for the overhead of a physical office space. We should call it an office fee that insurance pays. Although you also have to compensate for the overhead of in-person staff, commute time, paying for electricity, etc, i.e. all the stuff that goes into a working facility. Let's call it a facility fee. We can have insurance pay that in addition to the reimbursement they pay us for our professional services.




Got to say (as someone who does see patients in-person at a W2 job), this mindset is endemic among physicians and is why we're always losing to midlevels. Rather than advocating for higher income for yourself, you're satisfied with other psychiatrists making less. The irony is that there literally exists a mechanism to compensate people more for in-person. Makes way more sense to make changes to get that to reflect in higher in-person salaries than to advocate for lower salaries. Especially because all you're doing is created a downward pressure on psychiatry income, which is then going to reflect in lower income for the in-person people too.

Facility fees have nothing to do with in person vs not in person. They have to do with whether a clinic is hospital owned or not. Hospitals have charged patients facility fees for virtual appointments.

People are already pissed off at hospitals for facility fees…there was a huge story couple days ago about Cleveland clinic doing this in Florida when they bought out a bunch of other practices. Don’t think that’s exactly the way to get a bunch of sympathy for doctors.

 

[Dopamemes]

Facility fees have nothing to do with in person vs not in person. They have to do with whether a clinic is hospital owned or not. Hospitals have charged patients facility fees for virtual appointments.

People are already pissed off at hospitals for facility fees…there was a huge story couple days ago about Cleveland clinic doing this in Florida when they bought out a bunch of other practices. Don’t think that’s exactly the way to get a bunch of sympathy for doctors.

Facility fees have to do with where the doctor is. If you see a patient while you are physically inside the hospital, the hospital can bill the facility fee.

So yes, facility fees absolutely have everything to do with the doctor coming in-person. Instead of clamoring for lower pay, clamor to get a cut of facility fees and clamor to get private practices facility fee reimbursement. Have a growth mindset instead of a crab mentality.

 

[allantois]

I won’t be surprised if other insurers jump on this wagon

 

[randomdoc1]

I won’t be surprised if other insurers jump on this wagon

It's too easy. I don't trust United, they always had slimey financial practices. got my eye on them. Especially since BCBS has in some areas, other payers will be eager to follow the lead.

 

[comp1]

I am not following the facility fee. You can see inpatients remotely. They are billing a facility fee still. How do outpatient "facility fees" work? Is this some IOP thing? You can also do that remotely.

 

[Dopamemes]

I am not following the facility fee. You can see inpatients remotely. They are billing a facility fee still. How do outpatient "facility fees" work? Is this some IOP thing? You can also do that remotely.

No, not an "IOP thing". Facility fees exist for outpatient visits as well.

 

[Stagg737]

Facility fees have to do with where the doctor is. If you see a patient while you are physically inside the hospital, the hospital can bill the facility fee.

So yes, facility fees absolutely have everything to do with the doctor coming in-person. Instead of clamoring for lower pay, clamor to get a cut of facility fees and clamor to get private practices facility fee reimbursement. Have a growth mindset instead of a crab mentality.

This is backwards. Facility fees for CMS are billed based on originating site, which is where the patient is located. If the patient is located at home, it does not matter where the physician is, you can't collect the facility fee for CMS. It's part of why the clinics I see referrals from only hound me to get my notes signed after 3-4 days when the patients go into their clinics for appointments.

CMS policy update from April of this year. Billing and facility fees are on page 7: https://www.cms.gov/files/document/mln901705-telehealth-remote-patient-monitoring.pdf

Some states may have different policies through Medicaid and of course private insurance will do whatever they want.

I am not following the facility fee. You can see inpatients remotely. They are billing a facility fee still. How do outpatient "facility fees" work? Is this some IOP thing? You can also do that remotely.

To bill an outpatient facility fee the patient just goes into a qualifying facility for the appointment. I see patients across the state and some of them go into their clinics and connect via an ipad. If they're in the clinic it doesn't matter where I'm at (our hospital or if I work from home), we can collect the facility fee (~$30).

 

[comp1]

Okay, so I definitely never knew anything about outpatient facility fees before. I'm kind of concerned they exist and it looks like at least a couple of states have banned them all together. A couple more have banned them for telehealth (regardless of origination), but not all or even a significant number. I guess that means in other states you can still charge facility fees for telehealth? I assume the concept is you are paying for the receptionist or some sort of care integration with the hospital (if ever needed) and that would still exist with telehealth.

 

[Stagg737]

Okay, so I definitely never knew anything about outpatient facility fees before. I'm kind of concerned they exist and it looks like at least a couple of states have banned them all together. A couple more have banned them for telehealth (regardless of origination), but not all or even a significant number. I guess that means in other states you can still charge facility fees for telehealth? I assume the concept is you are paying for the receptionist or some sort of care integration with the hospital (if ever needed) and that would still exist with telehealth.

That is the idea. When I see people across the state some of them have problems getting connected. A couple weeks ago we literally spent 25 minutes trying to help a woman connect and when she finally got video working there was no sound. It was on her phone so she couldn’t even call from another device so we just rescheduled and she had to go into the clinic.

The facility fee is the same as if you were face to face. Physical space, staff to room the patient and get them set up for telehealth, is of the office equipment, etc. since all but one of the clinics I see patients from are affiliated with the local hospitals, they charge the facility fee when the patients physically go in. I’d say probably 1/4-1/3 of my patients go into clinic to connect with me.

 

[randomdoc1]

That is the idea. When I see people across the state some of them have problems getting connected. A couple weeks ago we literally spent 25 minutes trying to help a woman connect and when she finally got video working there was no sound. It was on her phone so she couldn’t even call from another device so we just rescheduled and she had to go into the clinic.

The facility fee is the same as if you were face to face. Physical space, staff to room the patient and get them set up for telehealth, is of the office equipment, etc. since all but one of the clinics I see patients from are affiliated with the local hospitals, they charge the facility fee when the patients physically go in. I’d say probably 1/4-1/3 of my patients go into clinic to connect with me.

Here's a hack for the patient you mentioned! leave the video on (like on doximity or something) and call her from a blocked number. She can have you on speaker. So you got audio and visual working simultaneously! I've done that with some patients. Kinda clunky but it works. Just a pet peeve of mine. I don't like phone call only (and rescheduling delays plus revenue loss), it's really bad. A very very low grade visit. I need to at minimum visualize and hear the person in real time. If I can't, I reschedule it...phone call...just can't do it. Of course, in extenuating circumstances I make sure nothing is super urgent before I hit the reschedule but the times people took me up on the phone call in the course of my career is less than 3.

It also really made me sick in the stomach in terms of providers who were perfectly ok with having "telephone patients" and billing them fraudulently as AV. Gross. I can see how things like the following happened with misuse of telehealth
-tardive dyskinesia
-missed major differential diagnosis
-higher permanent patient drop out of care and negative impression of mental health providers--leaving them reluctant to engage with a provider again
-etc.

I get so many calls to the clinic from prospective patients saying, if there is no option on their terms to have in person versus virtual visits, it is a deal breaker and they will not establish. A lot of patients (especially motivated patients focused on their wellness and financially reliable ones) have verbalized they are sick of some of the things that happened with telehealth. And they have a point, it is patient autonomy, to have choices in their care.

 

[Dr. Pookie]

I have a physical office, but I feel like I'm going to lose quite a few patients because of this. Probably 40% of my caseload is telehealth and I just have a feeling that when I tell them that they're going to all have to start coming in person "because their insurance requires it," - it won't land well. I'm sure many of these patients only continue seeing me because it's convenient for them. Also, will probably drive up no-shows. 🙁

Not really seeing a silver lining here.

 

[MedMan80]

Sucks for the folks at talkiatry