2018 Reimbursement Codes for Telemedicine

CY 2018 Medicare Telehealth Service Codes with Example Pricing: Reflects the National Payment Amount based on the Calendar Year (CY) Physician Fee Schedule Total Non-Facility RVUs and CY 2018 Modifier ($35.99), where available.  Note that Facility and Non-Facility Pricing are sometimes the same (e.g., where code is a facility-only code).

 

Code Description Payment
90785 Psychiatric treatment interactive complexity add on code – refers to 4 specific communication factors during a visit that complicate delivery of the primary psychiatric procedure $14.76
90791 Psych diagnostic evaluation $136.40
90792 Psych diagnostic evaluation with additional medical services such as physical examination and prescription of pharmaceuticals are provided in addition to the diagnostic evaluation $152.60
90832 Psychotherapy, 30 minutes with patient $66.22
90833 Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedures: 99201-99255, 99304-99337, 99341-99350) $69.10
90834 Psychotherapy, 45 minutes with patient $88.54
90836 Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedures: 99201-99255, 99304-99337, 99341-99350) $87.10
90837 Psychotherapy, 60 minutes with patient $132.80
90838 Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedures: 99201-99255, 99304-99337, 99341-99350) $115.17
90845 Psychoanalysis $95.01
90846 Family psychotherapy (without the patient present), 50 minutes $106.89
90847 Family psychotherapy (conjoint psychotherapy)(with patient present), 50 minutes $111.21
90951 ESRD related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month $960.57
90952 ESRD related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 or more face-to-face visits by a physician or other qualified health care professional per month Contact MAC for pricing
90954 ESRD related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month $827.77
90955 ESRD related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 or more face-to-face visits by a physician or other qualified health care professional per month $464.63
90957 ESRD related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month $654.65
90958 ESRD related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 or more face-to-face visits by a physician or other qualified health care professional per month $444.12
90960 ESRD related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month $288.28
90961 ESRD related services monthly, for patients 20 years of age and older; with 2-3 or more face-to-face visits by a physician or other qualified health care professional per month. $242.57
90963 ESRD related services for home dialysis per full month, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents. $554.33
90964 ESRD related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents. $484.79
90965 ESRD related services for home dialysis per full month, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents. $461.03
90966 ESRD related services for home dialysis per full month, for patients 20 years of age and older. $241.85
90967 ESRD related services for home dialysis less than a full month, per day; for patients younger than 2 years of age. $18.35
90968 ESRD related services for home dialysis less than a full month, per day; for patients 2-11 years of age. $15.84
90969 ESRD related services for home dialysis less than a full month, per day; for patients 12-19 years of age. $15.47
90970 ESRD related services for home dialysis less than a full month, per day; for patients 20 years of age and older. $7.92
96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language , memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist’s or physician’s time, both face-to-face time with the patient and time interpreting test results and preparing the report. $95.37
96150 Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment $22.67
96151 Health and behavior re-assessment $21.95
96152 Health and behavior intervention, each 15 minutes, face-to-face, individual $20.87
96153 Health and behavior intervention group (2 or more patients) $4.68
96154 Health and behavior intervention family (with the patient present) $20.15
96160 Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument $3.96
96161 Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument $3.96
97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes. $35.27
97803 Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes. $30.59
97804 Medical nutrition therapy; group (2 or more individuals), each 30 minutes. $16.19
99201

Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components:

  • A problem focused history;
  • A problem focused examination;
  • Straightforward medical decision making.
$45.35
99202

Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components:

  • An expanded problem focused history;
  • An expanded problem focused examination;
  • Straightforward medical decision making.
$76.30
99203

Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components:

  • A detailed history;
  • A detailed examination;
  • Medical decision making of low complexity.
$109.77
99204

Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components:

  • A comprehensive history;
  • A comprehensive examination;
  • Medical decision making of moderate complexity.
$167.35
99205

Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components:

  • A comprehensive history;
  • A comprehensive examination;
  • Medical decision making of high complexity.
$210.54
99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. $21.95
99212

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components:

  • A problem focused history;
  • A problem focused examination;
  • Straightforward medical decision making.
$44.63
99213

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components:

  • An expanded problem focused history;
  • An expanded problem focused examination;
  • Straightforward medical decision making.
$74.14
99214

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these 3 key components:

  • A detailed history;
  • A detailed examination;
  • Medical decision making of low complexity.
$109.41
99215

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components:

  • A comprehensive history;
  • A comprehensive examination;
  • Medical decision making of high complexity.
$147.56
99231

Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 components:

  • A problem focused interval history;
  • A problem focused examination;
  • Medical decision making that is straightforward or of low complexity.
$39.95 (total facility)
99232

Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 components:

  • An expanded interval history;
  • An expanded examination;
  • Medical decision making of moderate complexity.
$74.14 (total facility)
99233

Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 components:

  • A detailed history;
  • A detailed examination;
  • Medical decision making of high complexity.
$106.17 (total facility)
99307

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 components:

  • A problem focused interval history;
  • A problem focused examination;
  • Straightforward medical decision making.
$45.35
99308

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 components:

  • An expanded problem focused interval history;
  • An expanded problem focused examination;
  • Medical decision making of moderate of low complexity.
$70.54
99309

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 components:

  • A detailed interval history;
  • A detailed examination;
  • Medical decision making of moderate complexity.
$93.21
99310

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 components:

  • A comprehensive interval history;
  • A comprehensive examination;
  • Medical decision making of high complexity.
$138.56
99354 Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management or psychotherapy service) $132.80
99355 Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (List separately in addition to code for prolonged service) $100.41
99356 Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient Evaluation and management service) $94.93 (total facility)
99357 Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; each additional 30 minutes (List separately in addition to code for prolonged service) $94.29 (total facility)
99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes $14.76
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes $28.43
99495

Transitional Care Management Services with the following required elements:

  • Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge
  • Medical decision making of at least moderate complexity during the service period
  • Face-to-face visit, within 14 calendar days of discharge
$166.99
99496

Transitional Care Management Services with the following required elements:

  • Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge
  • Medical decision making of high complexity during the service period
  • Face-to-face visit, within 7 calendar days of discharge
$236.45
99497 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate $87.10
99498 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure) $75.94

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Claudia Téllez

Author Claudia Téllez

Executive Director, Health Care Futurist

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