CMS has waived certain Medicare restrictions on digital communication in light of the COVID-19 pandemic, including "e-visits." Here is brief guide to using e-visits under Medicare. If you need more explanation, return to APTA's article "Furnishing and Billing E-Visits: Addressing Your Questions."
E-visits are "non face-to-face patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office."The code descriptors for the HCPCS codes related to e-visits indicate that the codes are intended to cover short-term (up to seven days) assessments and management activities that are conducted online or via some other digital platform and include any associated clinical decision-making.
An e-visit can comprise more than one communication between you and your patient, and includes all activities that you perform to meet the assessment and management needs as identified by the patient. The maximum duration of an e-visit is seven days.
An e-visit is not a treatment session, and it does not meet the Medicare definition of telehealth.
The seven-day period begins when you respond to the patient's request to initiate the e-visit and ends seven calendar days after that response.
You cannot bill an e-visit if you saw the patient in a face-to-face visit fewer than 7 days before the e-visit or if you see the patient in a face-to-face visit fewer than 7 days after the e-visit.
Documentation of an e-visit should include all communication and actions that you take, as well as the following:
- That the e-visit was initiated by the patient.
- That the patient consented to the e-visit.
- The clinical decision making that occurred as a result of the e-visit.
For Medicare, bill the e-visit once for the seven-day period. The code billed is based on the total time spent in that period. The HCPCS e-visit codes paid under the Medicare Physician Fee Schedule are:
- G2061: Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to seven days; cumulative time during the seven days, 5-10 minutes.
- G2062: Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to seven days; cumulative time during the seven days, 11-20 minutes.
- G2063: Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to seven days; cumulative time during the seven days, 21 or more minutes.
For outpatient claims, the place-of-service code is determined by place where you furnished the service. It does not matter where the corporate address of the billing provider is, nor does it matter what the beneficiaries’ addresses are. It matters where the service was rendered; that is, where the biller is located.
For institutional billing, the DR condition code and CR modifier both are required. For noninstitutional billing, only the CR modifier is required. The March 18 CMS MLN Matters article explains further. See also MCPM Chapter 38.
Examples of e-visits:
In each of these scenarios, an established patient initiates contact with the physical therapist.
- The patient contacts the physical therapist through the online portal and reports having difficulty performing one or more of their home exercises.
Using the portal, the PT asks the patient to provide details, also using the portal, regarding the difficulty. The PT reevaluates the program and makes a clinical determination to modify, replace, eliminate, or downgrade one of the exercises. The PT sends the updated program to the patient through the portal.
- The patient contacts the PT through the portal and reports being able to perform their home exercise program with ease and not feeling challenged.
Using the portal, the PT reviews the patient's home exercise program and makes a clinical determination to progress several of the exercises in intensity and add two new exercises. The PT sends the updated program to the patient through the portal.
- The patient contacts the PT through the portal and reports an increase in neck and shoulder pain.
Using the portal, the PT asks the patient to provide details about factors that may have contributed to the increased pain. The PT determines that the pain is associated with the patient spending more time sitting and working at a home computer. The PT develops an activity plan that calls for increased periods of physical activity and stretching exercises to perform throughout the day. The PT sends the program to the patient through the portal and asks the patient to report any changes.
- The patient, having missed several in-person appointments, contacts the PT through the portal and reports a concern regarding decreased flexibility in their postoperative knee.
Using the portal, the PT asks the patient to describe any movement-related changes, such as more difficulty getting out of a chair and not being able to get their foot back as far when sitting in a chair. The PT also asks the patient to provide, through the portal, a diary of activity and exercise throughout the day. The PT determines that the patient is sitting too long throughout the day and is not performing ROM exercises as frequently as prescribed. Using the portal, the PT provides the patient with a specific schedule of exercise and activity, and advises the patient to check back in through the portal in two days unless the patient experiences any other changes or difficulty before then.