Telehealth After The Public Health Emergency

Quest ion:

We understand we cannot use the facility charge of Q3014 anymore. Is this correct?Can we still bill the professional and facility levels associated with the telehealth visits?For example, 99201-99205 and 99211-992115 for a professional and a small facility charge to match?

Answ er:

Now that the Public Health Emergency (PHE) is over, hospitals may report Q3014 only if the patient comes to the facility to utilize HIPAA-compliant telehealth equipment while a distant site practitioner performs a telemedicine visit.

Although billing professionals may continue to bill Medicare for telehealth services (subject to Medicare?s ?List of Telehealth Servicesfor Calendar Year 2023?), hospitals may no longer report HCPCSQ3014 (Telehealth originating facility fee) to claim reimbursement for supporting a facility-based physician or non-physician practitioner performing a telemedicine service

In addition, telehealth equipment must be HIPAA compliant after 5/11/2023.

Remote services provided by facility staff (such as physical therapists, etc.) will no longer be covered by Medicare, except certain mental health or substance abuse disorder treatment reported with HCPCSC7900 ? C7902.)

An FAQ published by CMSoffers more guidance to billing after the PHEended. A link and an excerpt are provided for your review. I have also attached a paper that outlines the changes.

FAQs: CMSWaivers, Flexibilities, and the End of the COVID-19 Public Health Emergency

Telehealth Afterthepublichealth Emergency

FAQs: CMSWaivers, Flexibilities, and the End of the COVID-19 Public Health Emergency

17. At the end of the PHE, when can hospitals bill for: i The originating site facility fee (HCPCScode Q3014)? ii The clinic visit (HCPCScode G0463)? iii. Remote mental health services (HCPCScodes C7900 - C7902)?

Following the anticipated end of the PHE(May 11, 2023): i Hospitals cannot bill for this code after the PHEunless the beneficiary is located within a hospital and the beneficiary receives a Medicare telehealth service from an eligible distant site practitioner Only in these cases can the hospital bill for the originating site facility fee (HCPCScode Q3014). ii.If the beneficiary is within a hospital and receives a hospital outpatient clinic visit (including a mental/behavioral health visit) from a practitioner in the same physical location, then the hospital would bill for the clinic visit (HCPCScode G0463) iii.If the beneficiary is in their home and receives a mental/behavioral health service from hospital staff through the use of telecommunications technology and no separate professional service can be billed, then the hospital would bill for the applicable HCPCS C-code describing this service (HCPCScodes C7900 - C7902).

Proper Coding For Mammography With Digital Breast Tomosynthesis

Quest ion:

We are going live on June 1, 2023 with a new 3-D mammography machine. Are there any new codes we should be using for billing?We've looked at 77061, 7706 and 77063 for Breast Tomosynthesis Screening And Diagnostic, but we don't see a reimbursement. Can you provide some assistance?

Answ er:

Congratulations on your new equipment! That?s a wonderful enhancement to the hospital?s service to the community.

I have attached our coding matrix for mammography services, which was last updated in 2022; coding has not changed.

In summary, the codes you will need to report tomosynthesis are 77063 and G0279 for Medicare and MediCal (G0279 is diagnostic tomo, unilateral or bilateral). Not all commercial payers will accept G0279, they may require the hospital to report 77061 for a unilateral diagnostic or 77062 for bilateral diagnostic Medicare does not accept 77061 of 77062, it requires providers to report G0279 instead Both G0279 and 77063 are reimbursed by Medicare under the Medicare Physician Fee Schedule at $26.33 for the technical component.

Commercial payers who do not accept G-codes may prefer 77061-77062 for diagnostic tomosynthesis.

Like Medicare, Medi-Cal accepts/reimburses G0279 and 77063 for tomosynthesis Here are excerpts from the Medi-Cal fee schedule

Report the screening code 77063 under revenue code 0403 ? Other Imaging Services ? Screening Mammography.

Report the diagnostic code G0279 (or 77061-77062) under revenue code 0401 ? Other Imaging Services ?Diagnostic Mammography