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Telemedicine Billing Simplified – California

What’s important for most private practice doctors to grasp is that there is a lot of leeway when it comes to billing telemedicine billing. With all this COVID business, if you’ve converted most of your visits to virtual visits, you’re going to be able to collect the same fees as if you did them in-person.

Even if you think you didn’t handle all of the billing correctly, flag your charts so that you can go back in them and resubmit, if needed.

Yes, it might be a lot of work, but the regulations are changing daily, for the better. Most regulating bodies are mandating that insurance payers reimburse physical visits the same as virtual visits.

In the past, we referred to this discussion as the parity laws. California, for example, enacted parity requirements this back in 2019.

Telemedicine Billing

Yesterday, April 7, 2020, the DMHC made it even easier for physician to bill for telemedicine services.

This new requirement allows practices to bill for virtual visits the exact same way they would for an in-person visit. The same CPT code would be used as the physical visit.

The only additions are a “place of service” code – 02. As well as a modifier – 95, for synchronous telemedicine visits, or GQ, for asynchronous visits.

Again, for the telemedicine coding part:

  • regular CPT code
  • 02
  • 95/GQ

Barriers to Telemedicine

I won’t get into the weeds here, but needless to say that for years many large medical groups have lobbied to restrict telemedicine. This ensures that they keep their patient population to themselves, stifling any tech innovation.

Other matters which this DMHC letter outlines the following restriction on health plans, who otherwise would have done everything possible to fight this enforcement:

  • health plans cannot exclude a service just because it was done virtually
  • cannot place limits on virtual covered services
  • cannot force use of their own, approved 3rd party telemedicine company
  • cannot enforce a specific telemedicine credentialing pathway
  • cannot enforce a particular telemedicine platform/mode of communication

Telephone Calls

It’s absolutely idiotic that we even needed to have this discussion, but yes, even telephone calls are now considered a virtual visit.

Meaning that all of those phone calls you are making to the patient which were sapping you of time and energy can now be billed. Just be sure that you don’t give up any telemedicine billing opportunities.

All Health Plans

These regulations apply to Medicare, Medi-Cal, CHIP, and all commercial health plans in the state of California.

However, note, if you’re billing under Medicare, there are a few nuances, which I’ve highlighted on the many back-and-forths I’ve had with commenters on this website.

The CPT code for a virtual visit for medicare should be 99441-99443 if it’s a telephone visit and no video component was used. This doesn’t apply to a video attempt which failed, and for which a telephone visit was used instead.

And a virtual check in is billed as a G2012.

Further Resources

I’m sure a lot of new documents will come out. But I will attach the following PDF which you can review. It’s put out by the California Medical Association, in response to COVID and covers all relevant telehealth practices.

Telemedicine course, so that you complete your visits like a champ.

Telemedicine SOAP note documentation.

Minimizing telemedicine practice risk.

6 replies on “Telemedicine Billing Simplified – California”

If you strictly do telemedicine visits, do you have to furnish your own malpractice insurance?

Depends on your state’s requirement for malpractice coverage. My state doesn’t require it. But if you believe that you could be sued by a patient, it’s good to have it.

Anytime you beign or change the way you see patients it’s important to discuss it with your insurer. I agree, important to check and make sure you have coverage.

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