Virtual ‘check-in’ codes

Excerpted from page 44 of the September/October 2022 edition of AOA Focus. Written by the AOA’s Coding & Reimbursement Committee.

Medicare reimbursement of telehealth has long been a frustrating endeavor for physicians. Until the onset of the COVID-19 pandemic, telehealth reimbursement had been limited by geography, the location of the patient and provider, type of provider, and technological modality. Waivers enacted at the beginning of the pandemic removed these restrictions for the duration of the public health emergency. Even prior to the pandemic, the Centers for Medicare & Medicaid Services (CMS) had implemented new codes to capture time doctors spent with patients using store and forward and other technologies.

In January 2019, CMS began reimbursing for these virtual “check-ins” via a limited scope. These check-ins do not fall under the CMS list of telehealth services, thereby precluding providers from being able to use POS 02 or Modifier 95 on Medicare claims. However, they also are not subject to many of the restrictions that are applied to telehealth codes.

The HCPCS virtual check-in codes included in the 2019 Physician Fee Schedule are described below:

G2010 Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

G2012 Brief communication technology-based service (e.g., virtual check-in) by a physician or other qualified health care professional who can report E/M services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; five-10 minutes of medical discussion.

With the onset of the COVID-19 pandemic in early 2020, the creation of these codes was timely. Although many of the restrictions on telehealth reimbursement were temporarily lifted, providers could also maintain continuity of care by billing for virtual check-ins. And while doctors of optometry can bill for these codes, during the height of the pandemic in 2020, they were primarily used by internists and family practitioners. In fact, CMS felt that virtual check-ins had become so important for continuity of care that in 2022 the agency developed a new code for longer virtual check ins. The HCPCS code included in the 2022 Physician Fee Schedule is described below:

G2252 Brief communication technology-based service (e.g., virtual check-in) by a physician or other qualified health care professional who can report E/M services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.

G2252 is intended for situations when the severity of a patient’s problem is not necessarily likely to warrant an in-person visit, but when more than five-10 minutes is needed to make that assessment. The technology must be synchronous and is subject to the same billing requirements as the other virtual check-in codes. Doctors of optometry are eligible to bill for G2250.

For more information on Medicare’s virtual “check-in” codes and how to bill for them, contact the AOA’s Coding Experts at aksthecodingexpert@aoa.org or visit AOA Coding Today.

To bill Medicare for HCPCS codes G2010 and G2012, check out this fact sheet. Doctors of optometry are eligible to bill for these codes.