Coding Scenario: Coding for Virtual-Digital Visits
Virtual/Digital Visits
Note: These tables are informational, not advisory. The AAFP recommends that physicians verify each payer's policy and ask patients to verify their coverage ahead of appointments.
How do I code an e-visit (CPT 99421-99423) for a new or established patient for COVID-19-related or non-COVID-19-related care?
| Aetna | Anthem | Cigna | Humana |
UHC |
Medicare | |
|---|---|---|---|---|---|---|
| CPT Codes: 99421-99423 | ||||||
Place of Service (POS) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Not accepted |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Modifier |
None |
None |
None |
None |
None
|
|
Cost-share waiver |
Yes (in-network physicians only). Waived for out-of-network physicians for COVID-related visits. |
|
Yes (in-network physicians only). Waived for out-of-network physicians for COVID-related visits. |
Yes (in-network physicians only). Waived for out-of-network physicians for COVID-related visits. |
Optional |
|
Covers cost-share |
The AAFP is seeking additional information. |
|
Yes |
Yes |
No |
|
How do I code a virtual check-in (HCPCS codes G2012 and G2010) for a new or established patient for COVID19-related or non-COVID-19-related care?
| Aetna | Anthem | Cigna | Humana |
UHC |
Medicare | |
|---|---|---|---|---|---|---|
| HCPCS Codes: G2012, G2010 | ||||||
Place of Service (POS) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) *Only covering G2012 |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Modifier |
None |
None |
None
|
None |
None |
None
|
Cost-share waiver |
Yes (in-network physicians only). Waived for out-of-network physicians for COVID-related visits. |
|
Yes (in-network physicians only). Waived for out-of-network physicians for COVID-related visits. |
Yes (in-network physicians only). Waived for out-of-network physicians for COVID-related visits. |
Yes (in-network physicians only). Waived for out-of-network physicians for COVID-related visits. |
Optional |
Cover cost-share |
The AAFP is seeking additional information. |
|
Yes |
Yes |
Yes |
No |
Virtual/Digital Scenario Notes
Beginning March 1 and for the duration of the public health emergency, patient consent may be obtained either before or at the time of service.
Virtual check-ins and e-visits must technically be initiated by a patient; however, physicians and other providers may need to educate beneficiaries on the availability of the service prior to patient initiation.
As noted above, most payers are waiving cost-sharing for virtual check-ins and e-visits. Physicians may elect to waive cost-sharing for Medicare beneficiaries. However, Medicare will not cover the beneficiary’s cost-sharing and the service will be paid as usual.
There are no COVID-19-specific POS or modifier requirements for virtual check-ins or e-visits. Use the POS used for typical services.
COVID-19-related services should be assigned the appropriate COVID-19 ICD-10 diagnosis code. Coding guidance can be found on the CDC website. Cost-sharing waivers may not be applied to claims that do not include an appropriate COVID-19 ICD-10 diagnosis code.
Self-funded plans can develop their own policies and may opt out of some cost-sharing waivers. Similarly, Medicaid policies are established at the state-level. The AAFP recommends reaching out to your provider relations representatives or Medicare Administrative Contractors (MACs) to verify policies. The Center for Connected Health Policy is tracking COVID-19 Related State Actions.
Virtual Check-in (HCPCS Code G2012)
These are brief (5-10 minutes) conversations with a physician or other clinician to determine if an in-person visit is necessary.
The communication cannot be related to a medical visit within the previous seven days and cannot lead to medical visit within the next 24 hours (or soonest appointment available).
Physician or other clinician may respond to patient by telephone, audio/video, secure text messaging, email, or patient portal.
HCPCS code G2010 can be used when a captured video or image (store and forward) is sent to the physician. The physician must follow up with the patient within 24 business hours. The consultation must not originate from an evaluation and management (E/M) service provided within the previous seven days or lead to an E/M service within the next 24 hours (or soonest available appointment).
Medicare E-Visits (online digital evaluation and management services)
These are non-face-to-face, patient-initiated communications with the physician through an online patient portal. The communications can occur over a seven-day period, and the exchange must be stored permanently.
They are a time-based code. Physicians use the cumulative time for up to seven days to determine the level of service.
- Cumulative time includes review of the initial inquiry, review of patient records pertinent to the assessment of the patient’s problem, personal interaction with clinical staff focused on the patient’s problem, development of management plans (including generation of prescriptions or ordering of tests), and subsequent communication with the patient. Communication can occur through online, telephone, email, or other digitally supported communication
Physicians and other clinicians who may independently bill Medicare for E/M services can use the following codes.
- 99421: Online digital evaluation and management service, for a patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
- 99422: Online digital evaluation and management service, for a patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
- 99423: Online digital evaluation and management service, for a patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
E-visits should not be billed on the same day the physician reports an office visit E/M service (CPT codes 99201-99205 and 99211-99215) for the same patient. Additionally, e-visits should not be billed when using the following codes for the same communication:
- 99091
- 99339-99340
- 99374-99380
- 99487 and 99489
- 99495-99466
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
FQHCs and RHCs can bill for Virtual Communication Services using Healthcare Common Procedure Coding System (HCPCS) code G0071. Virtual communication services include:
- 5 or more minutes of virtual (non-face-to-face) communication between an FQHC or RHC practitioner and FQHC or RHC patient; or
- 5 or more minutes of remote evaluation of recorded video and/or images by an FQHC or RHC practitioner, occurring in lieu of an office visit; or
- online digital evaluation and management services for a patient, for up to 7 days, cumulative time during the seven days (5-10 minutes, 11-20 minutes, or 21 or more minutes).
These services can be provided to both new and established patients. They must be patient-initiated, and consent must be obtained before or at the time of service. The payment rate for G0071 is $24.76.