Billing for telehealth

Learn about policies and reimbursement for telehealth services.

Medicare

Many older adults are covered by Medicare fee-for-service. 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 and HCPCs codes	Description	Time	Audio-only coverage	Permanent coverage
98960	Self-management, individual patient	30 min	No	No
98961	Self-management, group (2-4 individuals)	30 min	No	No
98962	Self-management, group (5-8 individuals)	30 min	No	No
98966	Telephone call for assessment and management by non-physician	5-10 min	Yes	Yes
98967	Telephone call for assessment and management by non-physician	11-20 min	Yes	Yes
98968	Telephone call for assessment and management by non-physician	21-30 min	Yes	Yes
99202	Outpatient visit, new patient	15-29 min	No	Yes
99203	Outpatient visit, new patient	30-44 min	No	Yes
99204	Outpatient visit, new patient	45-59 min	No	Yes
99205	Outpatient visit, new patient	60-74 min	No	Yes
99211	Outpatient visit, established patient	5 min	No	Yes
99212	Outpatient visit, established patient	10-19 min	No	Yes
99213	Outpatient visit, established patient	20-29 min	No	Yes
99214	Outpatient visit, established patient	30-39 min	No	Yes
99215	Outpatient visit, established patient	40-55 min	No	Yes
99441	Telephone call for evaluation and management	5-10 min	Yes	No
99442	Telephone call for evaluation and management	11-20 min	Yes	No
99443	Telephone call for evaluation and management	21-30 min	Yes	No
G0438	Initial annual wellness visit	N/A	Yes	Yes
G0439	Subsequent annual wellness visit	N/A	Yes	Yes
G0506	Comprehensive assessment care plan	N/A	Yes	Yes
G2112	Prolonged outpatient visit	Additional 15 min	Yes	Yes

Disease management

CPT and HCPCs codes	Description	Time	Audio-only coverage	Permanent coverage
96156	Health behavior assessment	N/A	Yes	Yes
96158	Health behavior intervention	30 min	Yes	Yes
96159	Health behavior intervention	Additional 15 min	Yes	Yes
96160	Patient-focused health risk assessment using standardized instrument	N/A	Yes	Yes
96164	Health behavior intervention, group	30 min	Yes	Yes
96165	Health behavior intervention, group	Additional 15 min	Yes	Yes
96167	Health behavior intervention, patient with family	30 min	Yes	Yes
96168	Health behavior intervention, patient with family	Additional 15 min	Yes	Yes
96170	Health behavior intervention, family without patient	30 min	No	No
96171	Health behavior intervention, family without patient	Additional 15 min	No	No
97802	Medical nutrition therapy, initial assessment	15 min	Yes	Yes
97803	Medical nutrition, reassessment	15 min	Yes	Yes
97804	Medical nutrition, group assessment	30 min	Yes	Yes
99453	Remote patient monitoring (RPM) device set up	N/A	N/A	No
99454	Monitoring data from RPM	N/A	N/A	No
99457	Patient-provider communication related to RPM data	20 min	Yes	No
99458	Patient-provider communication related to RPM data	Additional 20 min	Yes	No
G0270	Medical nutrition therapy, reassessment, intervention	15 min	Yes	Yes
G0447	Obesity counseling	15 min	Yes	Yes

Cardiovascular conditions

CPT and HCPCs codes	Description	Time	Audio-only coverage	Permanent coverage
93750	Interrogation of ventricular assist device	N/A	No	No
93797	Cardiac rehabilitation, without ECG	60 min	No	No
93798	Cardiac rehabilitation, with ECG	60 min	No	No
99473	Self-measured blood pressure, education and training	N/A	No	No
G0422	Intensive cardiac rehabilitation, with exercise	60 min	No	No
G0423	Intensive cardiac rehabilitation, without exercise	60 min	No	No
G0446	Intensive behavioral therapy for cardiovascular disease	15 min	Yes	Yes

Pulmonary disease

CPT and HCPCs codes	Description	Time	Audio-only coverage	Permanent coverage
94005	Home ventilator management supervision	N/A	No	No
94625	Pulmonary rehabilitation, without monitoring	60 min	No	No
94626	Pulmonary rehabilitation, with monitoring	60 min	No	No
99664	Demonstration or evaluation of use of inhaler	N/A	No	No

Diabetes

CPT and HCPCs codes	Description	Time	Audio-only coverage	Permanent coverage
G0108	Diabetes self-management training, individual	30 min	Yes	Yes
G0109	Diabetes self-management training, group	30 min	Yes	Yes

Mental and behavioral health

CPT and HCPCs codes	Description	Time	Audio-only coverage	Permanent coverage
G0444	Annual depression screening	5-15 min	Yes	Yes
90785	Psychotherapy, with interactive complexity	N/A	Yes	Yes
90791	Psychological diagnostic evaluation	Up to 90 min	Yes	Yes
90792	Psychological diagnostic evaluation, with medical services	1-2 hours	Yes	Yes
90832	Psychotherapy, no medical evaluation	16-37 min	Yes	Yes
90833	Psychotherapy, with medical evaluation	30 min	Yes	Yes
90834	Psychotherapy, no medical evaluation	45 min	Yes	Yes
90836	Psychotherapy, with medical evaluation	45 min	Yes	Yes
90837	Psychotherapy, no medical evaluation	Additional time	Yes	Yes
90838	Psychotherapy, with medical evaluation	Additional time	Yes	Yes
90839	Psychotherapy for crisis	60 min	Yes	Yes
90840	Psychotherapy for crisis	Additional 30 min	Yes	Yes
90845	Psychoanalysis	N/A	Yes	Yes
90846	Family psychotherapy, without patient	26 or more min	Yes	Yes
90847	Family psychotherapy, with patient	26 or more min	Yes	Yes
90853	Group psychotherapy	45-60 min	Yes	Yes

Medicare Advantage

Many individuals have Medicare Advantage. Medicare Advantage plans may cover additional telehealth services or reduce cost-sharing. Check out the telehealth benefits for the Medicare Advantage plans in your area.

Dual eligible Medicare and Medicaid beneficiaries

Older adults who have dual eligibility to Medicare and Medicaid may have limited resources. Each state has its own billing and reimbursement policies. For tips on Medicaid policies, visit Medicaid and Medicare overview.

Private insurance

Check with the patient’s insurance company for information on their billing and reimbursement policies. For tips on private insurance policies, look up policy by jurisdiction.

More information:

Billing for Providers – What Should I Know? (PDF) — Health Resources and Services Administration

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

Understanding telehealth policy — National Policy Telehealth Resource Center

Last updated: July 29, 2024

Telehealth for older adults