Billing for telehealth for chronic disease prevention and management
Learn more about policies and reimbursement for telehealth services for chronic disease.
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 | Time |
|---|---|---|
| 96156 | Health behavior assessment | N/A |
| 96158 | Health behavior intervention | 30 min |
| 96159 | Health behavior intervention | Additional 15 min |
| 96160 | Patient-focused health risk assessment using standardized instrument | N/A |
| 96164 | Health behavior intervention, group | 30 min |
| 96165 | Health behavior intervention, group | Additional 15 min |
| 96167 | Health behavior intervention, patient with family | 30 min |
| 96168 | Health behavior intervention, patient with family | Additional 15 min |
| 96170 | Health behavior intervention, family without patient | 30 min |
| 96171 | Health behavior intervention, family without patient | Additional 15 min |
| 97802 | Medical nutrition, initial assessment | 15 min |
| 97803 | Medical nutrition, reassessment | 15 min |
| 97804 | Medical nutrition, group assessment | 30 min |
| 98960 | Self-management training, individual patient | 30 min |
| 98961 | Self-management training, group (2-4 individuals) | 30 min |
| 98962 | Self-management training, group (5-8 individuals) | 30 min |
| 98966 | Telephone call for assessment and management by non-physician` | 5-10 min |
| 98967 | Telephone call for assessment and management by non-physician` | 11-20 min |
| 98968 | Telephone call for assessment and management by non-physician` | 21-30 min |
| 99202 | Outpatient visit (new patient) | 15-29 min |
| 99203 | Outpatient visit (new patient) | 30-44 min |
| 99204 | Outpatient visit (new patient) | 45-59 min |
| 99205 | Outpatient visit (new patient) | 70-74 min |
| 99211 | Outpatient visit (established patient) | 5 min |
| 99212 | Outpatient visit (established patient) | 10-19 min |
| 99213 | Outpatient visit (established patient) | 20-29 min |
| 99214 | Outpatient visit (established patient) | 30-39 min |
| 99215 | Outpatient visit (established patient) | 40-55 min |
| 99406 | Tobacco and smoking cessation counseling | 3-10 min |
| 99407 | Tobacco and smoking cessation counseling | More than 10 min minutes |
| G0270 | Medical nutrition therapy, reassessment, intervention | 15 min |
| G0438 | Initial annual wellness visit | N/A |
| G0439 | Subsequent annual wellness visit | N/A |
| G0447 | Obesity counseling | 15 min |
| G0506 | Comprehensive assessment care plan | N/A |
| G0513 | Prolonged prevention services | 30 min |
| G0514 | Prolonged prevention services | Additional 30 min |
| G2212 | Prolonged outpatient visit | Additional 15 min |
| G3002 | Chronic pain treatment | 30 min |
| G3003 | Chronic pain treatment | Additional 15 min |
Cardiovascular conditions
| CPT/HCPCs code | Description | Time |
|---|---|---|
| 93750 | Interrogation of ventricular assist device | N/A |
| 93797 | Cardiac rehabilitation, without ECG | 60 min |
| 93798 | Cardiac rehabilitation, with ECG | 60 min |
| G0422 | Intensive cardiac rehabilitation with exercise | 60 min |
| G0423 | Intensive cardiac rehabilitation without exercise | 60 min |
| G0446 | Intensive behavioral therapy for cardiovascular disease | 15 min |
Pulmonary conditions
| CPT/HCPCs code | Description | Time |
|---|---|---|
| 94005 | Home ventilator management supervision | N/A |
| 94625 | Pulmonary rehabilitation without monitoring | 60 min |
| 94626 | Pulmonary rehabilitation with monitoring | 60 min |
| 94664 | Demonstration or evaluation of use of inhaler | N/A |
Diabetes
| CPT/HCPCs code | Description | Time |
|---|---|---|
| G0108 | Diabetes self-management training, individual | 30 min |
| G0109 | Diabetes self-management training, group | 30 min |
Cancer
| CPT/HCPCs code | Description | Time |
|---|---|---|
| 77427 | Radiation oncology treatment management | N/A |
Behavioral health
| CPT/HCPCs code | Description | Time |
|---|---|---|
| 90785 | Psychotherapy with interactive complexity | N/A |
| 90791 | Psychological diagnostic evaluation | Up to 90 min |
| 90792 | Psychological diagnostic evaluation with medical services | 1-2 hours |
| 90832 | Psychotherapy, no medical evaluation | 30 min |
| 90833 | Psychotherapy, with medical evaluation | 30 min |
| 90834 | Psychotherapy, no medical evaluation | 45 min |
| 90836 | Psychotherapy, with medical evaluation | 45 min |
| 90836 | Psychotherapy, with medical evaluation | 45 min |
| 90837 | Psychotherapy, no medical evaluation | 60 min |
| 90838 | Psychotherapy, with medical evaluation | 60 min |
| 90839 | Psychotherapy for crisis | 60 min |
| 90840 | Psychotherapy for crisis | Additional 30 min |
| G0397 | Alcohol and substance misuse assessment | 30 or more min |
| G0442 | Alcohol and substance misuse screening | 5-15 min |
| G0443 | Alcohol and substance misuse counseling | 5-15 min |
| G044 | Annual depression screening | 5-15 min |
Tip: Explore 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 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 a policy by its 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
Understanding telehealth policy — National Telehealth Policy Resource Center