Nearly 250 new Current Procedural Terminology (CPT) codes went into effect at the beginning of this year. Among these additions are six new codes for patient evaluation and management (E/M) services provided via digital communication.
Physicians and other qualified health care professionals can now be reimbursed for using digital tools such as online messaging portals to evaluate and monitor their patients. In short, the electronic visit (“e-visit”) is now an AMA-codified practice.
“With the advance of new technologies for e-visits and health monitoring, many patients are realizing the best access point for physician care is once again their home,” said psychiatrist and AMA President Patrice Harris, M.D., in a statement. “The new CPT codes will promote the integration of these home-based services that can be a significant part of a digital solution for expanding access to health care, preventing and managing chronic disease, and overcoming geographic and socioeconomic barriers to care.”
The six new digital health CPT codes are 99421, 99422, 99423, 98970, 98971, and 98972. The first three codes enable physicians to seek reimbursement for digital evaluations with patients that take 5 to 10 minutes, 11 to 20 minutes, or over 21 minutes, respectively. The second set of three reflect the same services but are used when nonphysician professionals perform the digital evaluation. All of these codes are restricted to digital evaluations for established patients, and the patient must initiate the digital contact.
Other key details about using these codes include the following:
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The patient cannot have been seen in the seven days prior to or seven days after making online contact. If the patient had been seen in the seven days prior to making online contact, the contact is not reported. If the patient has an in-person evaluation within seven days after making contact, the time spent on the online digital service is incorporated into the appropriate in-person E/M service code.
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The digital evaluation can be cumulative over a seven-day period and includes not only the time spent in online communications but also time needed to review pertinent patient records and consult with relevant clinical staff.
These new e-visit codes arose from the AMA’s Digital Medicine Payment Advisory Group (DMPAG), a panel of physicians and industry leaders with expertise in telemedicine and other digital health tools. Formed in 2017, the DMPAG is tasked with developing clear and consistent billing codes that can help shepherd effective digital tools toward widespread practice. As Laurie McGraw, the senior vice president for Health Solutions at AMA explained at the 2019 HLTH conference in Las Vegas, “If you want adoption, you need payment.”
McGraw added that DMPAG is doing more than creating billing codes. They are also advocating for more regulatory changes to reduce the burdens doctors face when trying to implement digital tools. One major initiative is changing state policies to enable more freedom in practicing telemedicine across state lines. ■
More information on CPT changes for 2020 is posted on APA’s website
here.
