Medicare’s virtual check-in codes
AOA Coding Experts Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D.
The AOA has long supported appropriate use of telehealth services that rely on an established doctor-patient relationship. For 2019, the Centers for Medicare & Medicaid Services (CMS) established a policy to pay separately for two new physicians' services that are provided with the use of communication technology:
HCPCS code G2012: Brief communication technology-based service (e.g., virtual check-in)
HCPCS code G2010: Remote evaluation of recorded video and/or images submitted by an established patient
Doctors of optometry can now be paid separately for G2012 when a patient checks in with the doctor by phone or through another telecommunications device to decide if an in-person office visit, or if different patient care, may be necessary. CMS believes that this new service can help to increase efficiency.
For more information regarding the requirements for billing these services, review the 2019 Final Rule, pages 59483 to 59489.
G2010 is intended to be reported when a doctor reviews recorded video and/or images submitted by an established patient. Doctors of optometry and other physicians can now be reimbursed for reviewing patient-transmitted photo or video information conducted via pre-recorded "store and forward" video or image technology. Again, the use of this technology and the physician's review is intended to determine whether an in-person visit is needed.
Reimbursement for these services varies by geographic location. For G2012 the range of reimbursement is approximately $12 to $18, while for G2010 reimbursement is approximately $8 to $16. To find reimbursement in your area, access the Medicare fee schedule look up.
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Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2024, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.