| Effective Date:08/06/2004 |
Title:Non Face-to-Face Services
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| Revision Date:10/01/2023
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Document:BI063:00
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| CPT Code(s):99441-99444, 99446-99449, 93293-93299, 98966-98969, 98970, 98971, 98972, 99421, 99422, 99423, G2061, G2062, G2063, G2066, 99451-99452, 99484, 99492, 99493, 99494
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Public Statement
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Effective Date:
a)
This policy will apply to
all services performed on or after the above revision date which will become the
new effective date.
b)
For all services referred
to in this policy that were performed before the revision date, contact customer
service for the rules that would apply.
1)
Health Care Professionals
will often contact and respond to patients by telephone, email, or other
electronic means.
2)
These services are
considered part of the overall services rendered by a Health Care Professional
and are not covered under normal circumstances.
3)
Please refer to BI529 for
telemedicine services.
4)
Telephone recording and
analysis of various cardiac monitoring and pacing devices are covered.
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Medical Statement
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1)
Non face-to-face
services, such as by telephone, email or other electronic means are generally,
are not covered under normal circumstances.
2)
All services that are not
provided by a provider physically located with the patient are considered
non-face-to-face.
3)
Following
non-face-to-face services to promote behavioral health integration are covered
without prior authorization (medical records for these services may be requested
for review to ensure CMS documentation requirements):
a) Interprofessional services (99446-99449
and 99451,
99452),
b) Behavioral Health Care coordination (99484),
c) Psychiatric Collaborative Care
Management (99492, 99493 and 99494).
4)
Telephonic monitoring of
cardiac pacing and monitoring devices are covered.
5)
Please refer to BI529 for
telemedicine services.
Codes
Used In This BI:
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93293
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Transtelephonic rhythm strip pacemaker eval, sgl, dual, or mult
lead pacemaker syst, incl recording w/ & w/out magnet applic w/analysis,
rvw & rpt by physician or other qual hlth care prof, up to 90 days
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93294
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Interrogation dvc eval (remote), up to 90 days; sgl, dual, or
mult lead pacemaker system, or leadless pacemaker system w/interim
analysis, rvw & rpt by a physician or other qual hlth care prof
(code revised 1/1/19)
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93295
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Interrogation dvc eval (remote), up to 90 days; sgl, dual, or
mult lead implantable defibrillator system w/interim analysis, rvw & rpt
by a physician or other qual hlth care prof
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93296
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Interrogation dvc eval (remote), up to 90 days; sgl, dual, or
mult lead pacemaker system, leadless pacemaker system, or implantable
defib system, remote data acquisition(s), receipt of transmissions &
tech rvw, tech support & distrib of results
(code revised 1/1/19)
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93297
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Interrogation dvc eval (remote), up to 30 days; implantable
cardio physiologic monitor system, incl analysis of 1 or more recorded
physiologic cardio data elements frm all internal & external sensors,
analysis, rvw & rpts by a physician or other qual hlth care prof
(code revised 1/1/19)
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93298
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Interrogation dvc eval (remote), up to 30 days; subcutan cardiac
rhythm monitor system, incl analysis of recorded heart rhythm data,
analysis, rvw(s) & rpts by a physician or other qual hlth care prof
(code revised 1/1/19)
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93299
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Interrogation dvc
eval (remote), up to 30 days; implantable cardio physiologic monitor
system or SC cardiac rhythm monitor syst, remote data acquisition(s),
receipt of transmissions & techn rvw, tech support & distribution of
results (code revised 1/1/19)
(deleted code eff 01/01/2020 & replaced by code G2066)
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98966
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Telephone assessment & mgmt svc provided by a qual nonphysician
hlth care prof to an estab pt, parent, or guardian not originating frm a
related assessment & mgmt svc provided w/in the prv 7 dys nor leading to
an assessment & mgmt svc or proc w/in the nxt 24 hrs or soonest avail
appt; 5-10 min of med discussion
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98967
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Telephone assessment & mgmt svc provided by a qual nonphysician
hlth care prof to an estab pt, parent, or guardian not originating frm a
related assessment & mgmt svc provided w/in the prv 7 dys nor leading to
an assessment & mgmt svc or proc w/in the nxt 24 hrs or soonest avail
appt; 11-20 min of med discussion
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98968
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Telephone assessment & mgmt svc provided by a qual nonphysician
hlth care prof to an estab pt, parent, or guardian not originating frm a
related assessment & mgmt svc provided w/in the prv 7 dys nor leading to
an assessment & mgmt svc or proc w/in the nxt 24 hrs or soonest avail
appt; 21-30 min of med discussion
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98969
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Online assessment & mgmt svc provided by a qual nonphysician hlth
care prof to an estab pt or guardian, not originating frm a related
assessment & mgmt svc provided w/in the prv 7 dys , using the Internet
or similar electronic communications network
Deleted code eff 01/01/2020
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98970
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QNHP ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MIN
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98971
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QNHP ONLINE DIGITAL E/M SVC EST PT <7 D 11-20MIN
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98972
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QNHP ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MIN
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99421
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ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES
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99422
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ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES
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99423
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ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES
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99441
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Telephone E/M svc by physician or other qual hlth care prof who
may rpt E/M svcs provided to an estab pt, parent, or guardian not
originating frm a related E/M svc provided w/in the prv 7 dys nor
leading to an E/M svc or proc w/in the nxt 24 hrs or soonest avail appt;
5-10 min of med discussion
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99442
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Telephone E/M svc by physician or other qual hlth care prof who
may rpt E/M svcs provided to an estab pt, parent, or guardian not
originating frm a related E/M svc provided w/in the prv 7 dys nor
leading to an E/M svc or proc w/in the nxt 24 hrs or soonest avail appt;
11-20 min of med discussion
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99443
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Telephone E/M svc by physician or other qual hlth care prof who
may rpt E/M svcs provided to an estab pt, parent, or guardian not
originating frm a related E/M svc provided w/in the prv 7 dys nor
leading to an E/M svc or proc w/in the nxt 24 hrs or soonest avail appt;
21-30 min of med discussion
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99444
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Online E/M svc provided by a physician or other qual hlth care
prof who may rpt E/M svcs provided to an estab pt or guardian, not
originating frm a related E/M svc provided w/in the prv 7 dys, using the
Internet or similar electronic communications ntwk
Deleted code eff 01/01/2020
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99446
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Interprofessional telephone/Internet/electronic health record
assessment & mgmt svc provided by a consultative physician, incl a
verbal & written rpt to the pt`s treating/req physician or other qual
hlth care prof; 5-10 mn of medical consult discussion & rvw
(code revised 1/1/19)
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99447
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Interprofessional telephone/Internet/electronic health record
assessment & mgmt svc provided by a consultative physician, incl a
verbal & written rpt to the pt`s treating/req physician or other qual
hlth care prof; 11-20 mn of medical consult discussion & rvw
(code revised 1/1/19)
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99448
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Interprofessional telephone/Internet/electronic health record
assessment & mgmt svc provided by a consultative physician, incl a
verbal & written rpt to the pt`s treating/req physician or other qual
hlth care prof; 21-30 mn of medical consult discussion & rvw
(code revised 1/1/19)
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99449
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Interprofessional telephone/Internet/electronic health record
assessment & mgmt svc provided by a consultative physician, incl a
verbal & written rpt to the pt`s treating/req physician or other qual
hlth care prof; 31 mn or more of medical consult discussion & rvw
(code revised 1/1/19)
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99451
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Interprofessional
telephone/internet/electronic health record assessment and management
service provided by a consultative physician, including a written report
to the patient`s treating/requesting physician or other qualified health
care professional, 5 minutes or more of medical consultative time.
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99452
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Interprofessional
telephone/Internet/electronic health record referral service(s) provided
by a treating/requesting physician or qualified healthcare professional.
It requires a minimum of 16 minutes. and can be billed every 14 days
when this time requirement is met.
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99484
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Care management services for behavioral health conditions, at least 20
minutes of clinical staff time, directed by a physician or other
qualified health care professional time, per calendar month
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99492
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Initial psychiatric collaborative care management, first 70 minutes in
the first calendar month of behavioral health care manager activities,
in consultation with a psychiatric consultant, and directed by the
treating physician or other qualified health care professional
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99493
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Subsequent psychiatric collaborative care management, first 60 minutes
in a subsequent month of behavioral health care manager activities, in
consultation with a psychiatric consultant, and directed by the treating
physician or other qualified health care professional
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99494
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Initial or subsequent psychiatric collaborative care management, each
additional 30 minutes in a calendar month of behavioral health care
manager activities, in consultation with a psychiatric consultant, and
directed by the treating physician or other qualified health care
professional (List separately in addition to code for primary procedure)
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G2061
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Qualified nonphysician health care professional
online assessment, for an established patient, for up to 7 days,
cumulative time during the 7 days; 5-10 minutes
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G2062
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Qualified nonphysician health care professional
online assessment service, for an established patient, for up to 7 days,
cumulative time during the 7 days; 11-20 minutes
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G2063
G2066
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Qualified nonphysician qualified health care
professional assessment service, for an established patient, for up to 7
days, cumulative time during the 7 days; 21 or more minutes
Interrogation device evaluation(s), (remote) up to 30 days; implantable
cardiovascular physiologic monitor system, implantable loop recorder
system, or subcutaneous cardiac rhythm monitor system, remote data
acquisition(s), receipt of transmissions and technician review,
technical support and distribution of results (replaced code 93299 eff
1/1/2020)
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Limits
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Intentially left empty
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Reference
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Addendum:
Effective 01/01/19:
Made reference to BI529 for telemedicine services.
2019 Code Updates:
Updated code description for CPT codes 93294, 93296, 93297, 93298, 93299, 99446,
99447, 99448, and 99449.
Effective 01/01/2020:
Code update – Added new codes and their descriptions 98970, 98971, 98972, 99421,
99422, 99423, G2061, G2062, G2063 and G2066 eff 01/01/2020.
Added these codes to the search box as well.
Deleted codes 98969, 99444 and 93299 eff 01/01/2020.
Effective
03/01/2021:
Following
non-face-to-face services to promote behavioral
health integration are covered: Interprofessional services (99446-99449
and 99451,
99452), Behavioral Health Care coordination (99484), and Psychiatric Collaborative Care Management (99492, 99493 and
99494). These services do not
require prior authorization. However, medical records may be requested to ensure
CMS documentation requirements are being met.
Added codes
99451, 99452, 99484, 99492, 99493, 99494 to the search box.
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Application to Products
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This policy applies to all health plans and products administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) or Certificate of Coverage (COC) for those plans or products insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC or COC, the SPD, EOC, or COC, as applicable, will prevail. State and federal mandates will be followed as they apply.
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Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
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