Notice: This CMS-approved document has been submitted - Philips ...
Notice: This CMS-approved document has been submitted - Philips ... Notice: This CMS-approved document has been submitted - Philips ...
CMS-1403-FC definition of a follow-up inpatient consultation and is not appropriate for delivery via telehealth. Follow-up inpatient telehealth consultations are subject to the criteria for consultation services, as described in the CMS Internet-Only Medicare Claims Processing Manual, Pub 100- 04, Chapter 12, §30.6.10. Payment for follow-up inpatient telehealth consultations includes all consultation related services furnished before, during, and after communicating with the patient via telehealth. Pre-service activities would include, but would not be limited to, reviewing patient data (for example, diagnostic and imaging studies, interim lab work) and communicating with other professionals or family members. Intra-service activities must include at least two of the three key elements described below for each procedure code. Post-service activities would include, but would not be limited to, completing medical records or other documentation and communicating results of the consultation and further care plans to other health care professionals. No additional E/M service could be billed for work related to a follow-up inpatient telehealth consultation. 116
CMS-1403-FC Follow-up inpatient telehealth consultations could be provided at various levels of complexity. To reflect this, we are establishing three codes. Practitioners taking a problem focused interval history, conducting a problem focused examination, and engaging in medical decision making that is straightforward or of low complexity, would bill a limited service, using HCPCS code G0406. At this level of service, practitioners would typically spend 15 minutes communicating with the patient via telehealth. Practitioners taking an expanded focused interval history, conducting an expanded problem focused examination, and engaging in medical decision making that is of moderate complexity, would bill an intermediate service using HCPCS code G0407. At this level of service, practitioners would typically spend 25 minutes communicating with the patient via telehealth. Practitioners taking a detailed interval history, conducting a detailed examination, and engaging in medical decision making that is of high complexity, would bill a complex service, using HCPCS code G0408. At this level of service, practitioners would typically spend 35 minutes or more communicating with the patient via telehealth. 117
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<strong>CMS</strong>-1403-FC<br />
Follow-up inpatient telehealth consultations could be<br />
provided at various levels of complexity. To reflect this,<br />
we are establishing three codes.<br />
Practitioners taking a problem focused interval<br />
history, conducting a problem focused examination, and<br />
engaging in medical decision making that is straightforward<br />
or of low complexity, would bill a limited service, using<br />
HCPCS code G0406. At this level of service, practitioners<br />
would typically spend 15 minutes communicating with the<br />
patient via telehealth.<br />
Practitioners taking an expanded focused interval<br />
history, conducting an expanded problem focused<br />
examination, and engaging in medical decision making that<br />
is of moderate complexity, would bill an intermediate<br />
service using HCPCS code G0407. At this level of service,<br />
practitioners would typically spend 25 minutes<br />
communicating with the patient via telehealth.<br />
Practitioners taking a detailed interval history,<br />
conducting a detailed examination, and engaging in medical<br />
decision making that is of high complexity, would bill a<br />
complex service, using HCPCS code G0408. At this level of<br />
service, practitioners would typically spend 35 minutes or<br />
more communicating with the patient via telehealth.<br />
117
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