Billing for hybrid telehealth services
Learn about policies and reimbursement for telehealth services.
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 | Permanent coverage |
|---|---|---|---|
| 98960 | Self-management, individual patient | 30 min | No |
| 98961 | Self-management training, group (2-4 individuals) | 30 min | No |
| 98962 | Self-management training, group (5-8 individuals) | 30 min | No |
| 98966 | Telephone call for assessment and management by non-physician | 5-10 min | Yes |
| 98967 | Telephone call for assessment and management by non-physician | 11-20 min | Yes |
| 98968 | Telephone call for assessment and management by non-physician | 21-30 min | Yes |
| 99202 | Outpatient visit (new patient) | 15-29 min | Yes |
| 99203 | Outpatient visit (new patient) | 30-44 min | Yes |
| 99204 | Outpatient visit (new patient) | 45-59 min | Yes |
| 99205 | Outpatient visit (new patient) | 60-74 min | Yes |
| 99211 | Outpatient visit (established patient) | 5 min | Yes |
| 99212 | Outpatient visit (established patient) | 10-19 min | Yes |
| 99213 | Outpatient visit (established patient) | 20-29 min | Yes |
| 99214 | Outpatient visit (established patient) | 30-39 min | Yes |
| 99215 | Outpatient visit (established patient) | 40-55 min | Yes |
| G0506 | Comprehensive assessment care plan | N/A | Yes |
| G2212 | Prolonged outpatient visit | Additional 15 min | Yes |
Disease management
| CPT/HCPCs Code | Description | Time | Permanent coverage |
|---|---|---|---|
| 96156 | Health behavior assessment | N/A | Yes |
| 96158 | Health behavior intervention | 30 min | Yes |
| 96159 | Health behavior intervention | Additional 15 min | Yes |
| 96160 | Patient-focused health risk assessment using standardized instrument | N/A | Yes |
| 96164 | Health behavior intervention, group | 30 min | Yes |
| 96165 | Health behavior intervention, group | Additional 15 min | Yes |
| 96167 | Health behavior intervention, patient with family | 30 min | Yes |
| 96168 | Health behavior intervention, patient with family | Additional 15 min | Yes |
| 96170 | Health behavior intervention, family without patient | 30 min | No |
| 96171 | Health behavior intervention, family without patient | Additional 15 min | No |
| 97802 | Medical nutrition therapy, initial assessment | 15 min | Yes |
| 97803 | Medical nutrition, re-assessment | 15 min | Yes |
| 97804 | Medical nutrition, group assessment | 30 min | Yes |
| 99453 | Remote patient monitoring (RPM) devices set up | N/A | No |
| 99454 | Monitoring data from RPM device | N/A | No |
| 99457 | Patient-provider communication related to RPM data | 20 min | No |
| 99458 | Patient-provider communication related to RPM data | Additional 20 min | No |
| G0270 | Medical nutrition therapy, reassessment, intervention | 15 min | Yes |
| G0447 | Obesity counseling | 15 min | Yes |
Cardiovascular conditions
| CPT/HCPCs Code | Description | Time | Permanent coverage |
|---|---|---|---|
| 93750 | Interrogation of ventricular assist device | N/A | No |
| 93797 | Cardiac rehabilitation, without ECG | 60 min | No |
| 93798 | Cardiac rehabilitation, with ECG | 60 min | No |
| 99473 | Self-measured blood pressure, education and training | N/A | No |
| G0422 | Intensive cardiac rehabilitation with exercise | 60 min | No |
| G0423 | Intensive cardiac rehabilitation without exercise | 60 min | No |
| G0446 | Intensive behavioral therapy for cardiovascular disease | 15 min | Yes |
Pulmonary disease
| CPT/HCPCs Code | Description | Time | Permanent coverage |
|---|---|---|---|
| 94005 | Home ventilator management supervision | N/A | No |
| 94625 | Pulmonary rehabilitation, without monitoring | 60 min | No |
| 94626 | Pulmonary rehabilitation with monitoring | 60 min | No |
| 94664 | Demonstration or evaluation of use of inhaler | N/A | No |
Diabetes
| CPT/HCPCs Code | Description | Time | Permanent coverage |
|---|---|---|---|
| G0108 | Diabetes self-management training, individual | 30 min | Yes |
| G0109 | Diabetes self-management training, group | 30 min | Yes |
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 billing and reimbursement policies. For tips on private insurance policies, look up policy by jurisdiction.
More information:
Billing for telehealth — Health Resources and Services Administration
Medicare and Medicaid policies — Health Resources and Services Administration
Telehealth policy — Health Resources and Services Administration
Understanding telehealth policy — National Policy Telehealth Resource Center