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A health care provider speaks with a patient with H-I-V through telehealth.

Best practice guide

Telehealth for HIV care
For providers Best practice guides Telehealth for HIV care

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.

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, and include updates provided to the 2022 Medicare Physician Fee Schedule - PFS (PDF).

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.

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) exit disclaimer icon  (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 exit disclaimer icon  — 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 exit disclaimer icon  (PDF) — from Prime Health

Last updated: March 25, 2022

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