Billing for telehealth
Learn about policies and reimbursement for delivering telehealth services to American Indians and Alaska Natives.
On this page:
Medicare
Medicare policies for telehealth continue to evolve. For the latest information, view the list of telehealth services. The following Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes are frequently used to bill for telehealth services. Coding guidance is subject to change.
Primary care
| CPT/HCPCs code | Description |
|---|---|
| 98960 | Self-management, individual patient |
| 98961 | Self-management training, group (2-4 individuals) |
| 98962 | Self-management training, group (5-8 individuals) |
| 98966 | Telephone call for assessment and management by a qualified nonphysician health care professional |
| 98967 | Telephone call for assessment and management by a qualified nonphysician health care professional |
| 98968 | Telephone call for assessment and management by a qualified nonphysician health care professional |
| 99202 | Outpatient or other outpatient visit (new patient) |
| 99203 | Outpatient or other outpatient visit (new patient) |
| 99204 | Outpatient or other outpatient visit (new patient) |
| 99205 | Outpatient or other outpatient visit (new patient) |
| 99211 | Outpatient or other outpatient visit (established patient) |
| 99212 | Outpatient or other outpatient visit (established patient) |
| 99213 | Outpatient or other outpatient visit (established patient) |
| 99214 | Outpatient or other outpatient visit (established patient) |
| 99215 | Outpatient or other outpatient visit (established patient) |
| G0438 | Initial annual wellness visit |
| G0439 | Subsequent annual wellness visit |
| G0506 | Comprehensive assessment and care planning for a patient requiring chronic care management; add-on code |
| G2212 | Prolonged office or outpatient visit; add-on code |
Disease management
| CPT/HCPCs code | Description |
|---|---|
| 96156 | Health behavior assessment/reassessment |
| 96158 | Health behavior intervention |
| 96159 | Health behavior intervention; add-on code |
| 96160 | Patient-focused health risk assessment using standardized instrument |
| 96164 | Health behavior intervention, group |
| 96165 | Health behavior intervention, group; add-on code |
| 96167 | Health behavior intervention, patient with family |
| 96168 | Health behavior intervention, patient with family; add-on code |
| 96170 | Health behavior intervention, family without patient |
| 96171 | Health behavior intervention, family without patient; add-on code |
| 97802 | Medical nutrition therapy, initial assessment |
| 97803 | Medical nutrition, re-assessment and intervention |
| 97804 | Medical nutrition, group assessment |
| G0270 | Medical nutrition therapy reassessment and subsequent intervention following a second referral in the same year because of a change in diagnosis, condition, or treatment |
| G0447 | Obesity counseling |
Cardiovascular conditions
| CPT/HCPCs code | Description |
|---|---|
| 93750 | Interrogation of ventricular assist device |
| 99473 | Self-measured blood pressure device validation, patient education, training, and device calibration |
| G0446 | Intensive behavioral therapy for cardiovascular disease |
Pulmonary disease
| CPT/HCPCs code | Description |
|---|---|
| 94005 | Home ventilator management supervision |
| 94664 | Demonstration or evaluation of use of inhaler |
Diabetes
| CPT/HCPCs code | Description |
|---|---|
| G0108 | Diabetes self-management training, individual |
| G0109 | Diabetes self-management training, group |
Tobacco and substance use
| CPT/HCPCs code | Description |
|---|---|
| 99406 | Tobacco and smoking cessation counseling |
| 99407 | Tobacco and smoking cessation counseling |
| G0396 | Alcohol and substance misuse structured assessment and brief intervention |
| G0397 | Alcohol and substance misuse structured assessment and brief intervention |
| G0442 | Annual alcohol misuse screening |
| G0443 | Brief behavioral counseling for alcohol misuse |
| G2086 | Treatment for opioid use disorder, first month |
| G2087 | Treatment for opioid use disorder, subsequent months |
| G2088 | Treatment for opioid use disorder; add-on code |
Mental and behavioral health
| CPT/HCPCs code | Description |
|---|---|
| G0444 | Annual depression screening |
| 90785 | Psychotherapy with interactive complexity; add-on code |
| 90791 | Psychological diagnostic evaluation |
| 90792 | Psychological diagnostic evaluation with medical services |
| 90832 | Psychotherapy, no medical evaluation |
| 90833 | Psychotherapy with E/M; add-on code |
| 90834 | Psychotherapy, no medical evaluation |
| 90836 | Psychotherapy with E/M; add-on code |
| 90837 | Psychotherapy, no medical evaluation |
| 90838 | Psychotherapy with E/M; add-on code |
| 90839 | Psychotherapy for crisis |
| 90840 | Psychotherapy for crisis; add-on code |
| 90845 | Psychoanalysis |
| 90846 | Family psychotherapy without patient |
| 90847 | Family psychotherapy with patient |
| 90853 | Group psychotherapy |
Tip: Explore telehealth policies on billing for remote patient monitoring in Medicare.
Medicaid
Each state has its own billing and reimbursement policies. For tips on Medicaid policies, visit the Medicaid and Medicare overview.
Tip: Review your state Medicaid policies for implementation of the “four walls” exception for IHS and Tribal clinics. Also review other Indian health provisions, including out-of-pocket cost exemptions and 100 percent Federal Medical Assistance Percentage.
Private insurance
Find out if the patient has private insurance. If so, check with the patient's insurance company for information on their billing and reimbursement policies. For tips on private insurance policies, look up the policy by jurisdiction.
More information:
Billing for telehealth — Health Resources and Services Administration
Medicare and Medicaid policies — Health Resources and Services Administration
Medicare payment policies — Health Resources and Services Administration
Telehealth policy — Health Resources and Services Administration
Medicare for American Indians and Alaska Natives — Centers for Medicare and Medicaid Services
Understanding telehealth policy — National Telehealth Policy Resource Center