The ways that healthcare providers meet with their patients is always shifting, and the Covid-19 pandemic has quickly accelerated some of these changes. To prevent patients from putting themselves at risk by visiting a hospital or clinic, the federal government lifted a range of restrictions on the use of telehealth, which was previously limited to rural areas. Many healthcare providers, including chiropractors, are now embracing this modern and flexible approach to healthcare. But to work telehealth services into your practice, it’s vital that you know how to bill for them properly. Becoming familiar with online digital evaluation CPT codes is an important way to make sure you’re billing correctly and are all set to get paid on time. With EHR and insurance billing features, Healthie makes it seamless to chart on clients and create all kinds of claims. Click here to learn more about our Free Starter Plan.
Online digital evaluation CPT codes for chiropractors
The Centers For Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) have taken steps to ensure that any American can access all the services they need during the pandemic. It’s important that anyone, particularly those at high-risk of complications resulting from Covid-19, can still see their chiropractor or other healthcare provider when they need to.
On January 1, 2020, the AMA released a new set of CPT codes for online digital evaluation and management (E/M) services. These codes are specifically for appointments that established patients have initiated with their healthcare provider. They apply to appointments that would typically take place in an office, and require a clinical decision.
They range in value from around $16-$55 per unit based on Medicare’s fee schedule, although CPT code reimbursement through private insurers is often higher. These CPT codes are based on time, and should be billed as follows:
- 99421 CPT Code: online digital E/M service for an established patient for up to seven days. Cumulative time: 5-10 minutes.
- 99422 CPT Code: online digital E/M service for an established patient for up to seven days. Cumulative time: 11-20 minutes.
- 99423 CPT Code: online digital E/M service for an established patient for up to seven days. Cumulative time: 21 or more minutes.
How to use chiropractic online digital evaluation CPT codes
To use E/M codes 99421-99423 correctly, make sure that you’re putting “02” in box 24b on the CMS-1500 claim form. This indicates that you provided the service through a telecommunication system. You should also append modifier 95 (Synchronous Telehealth Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System) to the CPT code. While many insurers will still recognize and accept the GT modifier in place of the 95 modifier, this is becoming less common. If in doubt, check with the insurance provider, so that you can be sure you’ll be getting the maximum reimbursement. If you’re struggling to navigate this system on your own, look to Healthie to streamline payment processing, Superbill creation, and implementation. Simply click here to get started with a free plan today.
You should also remember that, like with many aspects of insurance billing, there are several regulatory guidelines to keep in mind. You can find the full list of regulations in the AMA CPT codebook, but the main requirements are that:
- The services are medically necessary.
- The patient is an established patient.
- The patient has initiated the service with an inquiry through the portal. Note that while it’s important that the patient initiates the service, you can still advertise to your established patients to let them know that you’re offering the service.
- You’re only using the CPT code once per patient in any seven day period.
- The service goes on longer than five minutes.
- You’re only using these CPT codes to bill for evaluative services. Non-evaluative services, such as explaining test results to patients or scheduling a follow-up appointment, must be billed as such.
- You’re not double counting time with a separate service, such as remote monitoring.
- You must provide these services via a HIPAA-compliant system, such as a secure telehealth communication platform.
How Healthie can make chiropractic telehealth easier
Incorporating telehealth into your practice can be complex, so it’s vital that you provide these services through an intuitive platform that you can rely on. With Healthie, you can:
- Enjoy using a fully HIPAA-compliant telehealth platform, allowing you to prioritize the security and privacy of your patients.
- Make high quality, immediate video calls to your patients.
- Easily view all your patient notes, billing information, and other details in one place.
- Electronically collect insurance details and other billing information from your patients.
- Reduce the time you spend on billing and administration with Healthie’s built-in automation, such as pre-filling of insurance forms.
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