Billing for telemedicine services

Sample Billing for telemedicine services. Hopefully you have understood how to schedule and bill for telemedicine services.

Categorized as Operations Tagged

Hopefully you understand what you can bill for.

It’s important to understand the telemedicine documentation requirements to avoid denials in the future. Make sure you instruct your providers accordingly as well.

Here’s a scenario for an ophthalmology practice

While I cannot list the requirements for all the specialties, here’s one from my own practice.

New patient 99202 — what you need to document

Providers need to document for new patients

  • An expanded problem focused history
  • An expanded problem focused examination
  • Straightforward medical decision making

This needs ALL 3 components:

  1. Chief complaint
  2. 1–3 elements of HPI
  3. Location
  4. Timing
  5. Context
  6. Quality
  7. Modifying factor
  8. Severity
  9. Duration
  10. Associated signs and symptoms
  11. System in the HPI (history of present illness)
  12. If medically necessary (if you do document it, this helps your group’s MIPS reporting next year)
  13. Past history
  14. Family history
  15. Social history

EXAM. Six to eight of the following 12 elements of the exam are performed

  1. Visual acuity — possible
  2. Ocular adnexa — possible
  3. Lens — not possible
  4. Confrontation visual fields — possible. (Can be done with family member)
  5. Pupil and iris
  6. Intraocular pressure — not possible.
  7. Extraocular motility — possible.
  8. Cornea — possible
  9. Optic nerve discs — not possible
  10. Conjunctiva — possible
  11. Anterior chamber — generally not possible
  12. Retina and vessels — not possible

MDM (Medical decision making)

  1. Diagnosis
  2. ICD10 — highest level of specificity please. Even if you have to add one each for OD OS, do it please.


  1. New problem to examiner: stable, improved or worsening
  2. Clinical lab test(s): ordered or reviewed
  3. Radiology tests: ordered or reviewed
  4. Other diagnostic tests: ordered or reviewed
  5. Review of old records and/or additional history from other than the patient. This generally means information gathered from sources other than the history and physical — lab tests, imaging, other diagnostic services, old records and history from sources other than the patient. Generally speaking, the guidelines ask that you record the decision to seek additional information and, if you have obtained the information, the results of your review of it.

Must meet one of the two categories:

  1. Presenting Problem(s) — One self-limited or minor problem
  2. Management Options Selected
  3. Observation
  4. Home care instructions, i.e. warm compresses, lid scrubs

Established Patient 99212 — what you need to document

Usually the presenting problems are of low severity. The same rules as above apply here as well.

  • An expanded problem focused history
  • An expanded problem focused examination
  • Straightforward medical decision making


Established Patient 99213 — what you need to document

For 99212 and 99213, you HAVE to have 2 out of these 3 components

  • Problem focused history
  • A problem focused examination
  • Medical decision making (This has to be present)

Usually the presenting problem(s) are of low to moderate severity

  1. The same points 1–7 as above
  2. For point 7, 99213 criteria is different
  3. Presenting Problem(s)
    1. Two or more self-limited or minor problems
    2. One stable chronic illness
    3. Acute uncomplicated illness or injury
  4. Management Options Selected
  5. Over-the-counter drugs or RX
  6. Minor surgery recommended with no identified risk factors

Providers need to document for ESTABLISHED patients

Visit timings (how long should they be)

  • 99201: 10 minutes
  • 99202: 20 minutes
  • 99203: 30 minutes
  • 99204: 45 minutes
  • 99205: 60 minutes
  • 99212: 10 minutes
  • 99213: 15 minutes
  • 99214: 25 minutes
  • 99215: 40 minutes

So how long should the visits be?

Follow this list below to understand what to code. 

Do keep in mind that all the time a physician spends during the telemedicine call, charting, reviewing patient data .. ALL of it counts.

  1. Code level selection is based on the same criteria for the base codes.
  2. Appending modifier -95 is optional during the public emergency.
  3. List place of service as 11 (same as an office location)

How to decide what’s billable and what’s not?

  1. If it was a video call — you can bill right away as a telehealth visit (based on the guides above)
  2. On the other hand, If it was a phone call, find out if the patient’s insurance covers phone calls or not. If the payor covers it, you can bill right away. This would be based on the guidelines mentioned above.
  3. If this is not covered, next step is to find out if the telephone encounter was related to an E/M 7 days prior or resulted in an E/M encounter within 24 hrs after this call.
  4. If the encounter did happen, then it is an un-billable visit. However, if it did NOT, then you need to ask whether this encounter included assessment and management of patient problem? If so — go ahead and bill this as a Telephone only E/M.
  5. For secure chat or secure email consults, first ask whether the patient initiated it or not. If the patient did not initiate it, then you cannot bill for it. But if the patient did initiate the consult via secure email/secure chat, you need to ask if this was related to an E/M 7 days prior. If it is, then you cannot bill for it. However, if it was not related to an E/M 7 days prior, ask yourself whether you are going to provide E/M service within the next 7 days or not. If not, then ask if you are going to provide E/M services in the next 24 hrs. If you are going to see the patient in the next 24 hrs AND you are going to include assessment and management of the patient problem, then you can go ahead and bill this as an eVisit.
  6. However, if you are going to provide services in the next 7 days, ask yourself whether the practice has seen this patient in the last 3 years or not (i.e. has this billing turned into a “new patient” visit or not). If the patient has not come in to see you in the past 3 years, then you cannot bill for it. However, if the patient has been seen in the last 3 years and you are going to provide services based on an image or a video that the patient sent, then go ahead and bill this as a “Virtual Checkin”.

Just follow this decision tree.

  1. Confirm patient identity (e.g., name, date of birth or other identifying information as needed, in particular if documenting independently from the patient’s electronic or paper record).
  2. Detail what occurred during the communication (e.g., patient problem(s), details of the encounter as warranted) to establish medical necessity.
  3. Document the total amount of time spent in communicating with the patient and only submit code G2012 if a minimum of five minutes of direct communication with the patient was achieved.
  4. Next, you should document that the nature of the call was not tied to a face-to-face office visit or procedure that occurred within the past seven days.
  5. Document that a subsequent office visit for the patient’s problems were not indicated within 24 hours or the next available appointment.
  6. Include that the patient provided consent for the service

What you need to do for virtual checkins (HCPCS code G2012) documentation requirements

These should get you started. 

Overall, if you pick a telemedicine technology platform that already includes billing assistance, that’s of great help.

Telemedicine is here to stay and our prediction is that it will be integrated into every willing practice’s clinical workflow to increase patient access to quality care.