Billing for HIV and telehealth
Many billing codes and payment policies for HIV diagnosis and management are the same whether used for telehealth or in-person services. There are, however, some codes specific to telehealth.
On this page:
As you are preparing to launch your HIV telehealth care program, take time to fully understand your billing options. You may need to consider extra staffing or additional training so your office is ready to seamlessly handle telehealth billing.
The COVID-19 public health emergency led the Centers for Medicare & Medicaid Services (CMS) to expand its coverage for telehealth care. Many state Medicaid programs and private insurers are also covering telehealth appointments the same as an in-person appointment, with patients paying their typical co-pays.
You can also choose to offer a discounted cash pay program or private payment options for the underinsured or the uninsured. One possible way to offer discounted payment is to find stakeholders willing to partner with you. You could also explore local, state, and federal grant funding options.
Get more information on billing for direct-to-consumer telehealth.
Medicare billing guidance
The following common Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes are used to bill for services for telemedicine in HIV care.
Coding guidance is subject to change. Please refer to the complete list of telehealth services covered by Medicare during the COVID-19 public health emergency from the Centers for Medicare & Medicaid Services. More information on Medicare coverage and policies for HIV/AIDS is available on the Centers for Medicare & Medicaid Services website
Audio-only or video telehealth
Category | Telehealth CPT codes and HCPCS codes |
---|---|
Evaluation and monitoring outpatient follow-up |
99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215 |
Observation care discharge |
99217* |
Initial observation care |
99218, 99219, 99220** |
Initial hospital care |
99221, 99222, 99223** |
Subsequent observational care |
99224, 99225, 99226 |
Subsequent hospital care |
99231, 99232, 99233 |
Telephone evaluation and monitoring service |
99441, 99442, 99443 |
Medical nutrition therapy |
97802, 97803 |
* Remains available until December 31, 2023
** Will expire at some point after the COVID-19 public health emergency is declared over
More resources
Medicare Coverage and Payment of Virtual Services (video) (video) — from the Centers for Medicare & Medicaid Services
Medicare telemedicine health care provider fact sheet — Centers for Medicare & Medicaid Services (CMS)
Current State Laws & Reimbursement Policies — from the National Policy Center - Center for Connected Health Policy
Alternative payment options
Other options for telehealth payment include:
- Offering a discounted cash pay program
- Subsidies from stakeholder partnerships or donations
- State and federal grants
Read more:
PrEP & PEP Billing Codes (PDF) — from Prime Health