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Medicare E-Visits

What is an E-Visit?

A non-face-to-face communication with their clinician without going to the doctor’s office by using and online patient portal. 

What is a patient portal?

A patient portal is a secure online website that gives patients convenient, 24-hour access to personal health information from anywhere with an Internet connection. 

Can I use other means to communicate with my patient? 

Effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.  For more information:https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

Codes

Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes:

    • G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
    • G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
    • G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

Place of Service Codes

Do not use the telehealth (02) POC code for E-visits. Therapists should use their normal POC code (11).

Modifiers

CMS guidance instructs providers to apply the CR (catastrophe/disaster related) modifier for both institutional and non-institutional Part B claims. For non-institutional billing, only CR modifier required.  For institutional billing, DR condition code and CR modifier required.

How many times can I bill for an E-visit?

Therapists can only bill once every seven (7) days. Add up the total time spent communicating with the patient over the 7-day period to determine which code to bill. 

For example, if PT has three visits with Mr. Jones during a 7-day period that cumulatively take 45 minutes, PT can bill only one G2063 unit and be paid a total of about $34

Who must initiate the communication?

The patient must generate the initial inquiry and communications can occur over a 7-day period.  However, practitioners may educate beneficiaries on the availability of the service prior to patient initiation. 

Can I use this service with a new patient?

No, these services can only be reported when the billing practice has an established relationship with the patient. This basically means that patient must have already had his or her initial evaluation.

Can assistants provide services through an E-visit?

Yes

How does this work with my progress report period?

E-visits do not count as one or more visits toward the 10-visit progress report requirement.

Is this limited to rural areas?

This is not limited to only rural settings. There are no geographic or location restrictions for these visits.

Do I need special patient consent for an E-Visit?

The patient must verbally consent to receive virtual check-in services.

Does the patient need to pay for these services?

The Medicare coinsurance and deductible would apply to these services.

Can I bill again after the initial 7-day period?

Yes. You may start another 7-day service after the first and bill for that after the second 7-day period ends.

How should E-visits be documented?

Documentation should show that patient initiated and consented to e-visit and briefly describe services provided, including clinical decision-making associated with the service.

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