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Hersh WR, Wallace JA, Patterson PK, et al. Telemedicine for the Medicare Population. Rockville (MD): Agency for Healthcare Research and Quality (US); 2001 Jul. (Evidence Reports/Technology Assessments, No. 24.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Telemedicine for the Medicare Population

Telemedicine for the Medicare Population.

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Appendix A. Procedure Code Review

As telemedicine services improve and demonstrate efficacy, they are likely to be reimbursed by Medicare and private insurers. There also needs to be, as stated in the main report, additional research in telemedicine's effectiveness. Both of these require a means for tracking telemedicine services utilization in patient care setting. A historic way to measure utilization is to track procedure codes used in claims for reimbursement by health care providers and organizations (e.g., hospitals, clinics, home health agencies).

An additional analysis of this study was to review selected procedure codes for their applicability to telemedicine services in the two of the three study areas: self-monitoring/testing and clinician-interactive services. We specifically identified which codes could be applied to these services and whether any services were currently being provided that could not be represented by the current codes.

Our analysis covered codes from Current Procedural Terminology (CPT -- a trademark of the American Medical Association, AMA) 1999 (2) and the Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS). (1) The HCPCS consists of codes for services covered by Medicare but not defined in the CPT system. Level I of HCPCS is the CPT system. Level II of HCPCS consists of over 2,400 additional codes added by HCFA for Medicare reimbursement, and has been in use since 1983. Level III of HCPCS consists of additional codes added by individual Medicare carriers.

The codes reviewed included those from the pathology, medicine, and evaluation and management chapters of CPT, along with selected HCPCS codes. (The CPT and HCPCS codes for inclusion were specified in our contract with the Agency for Healthcare Research and Quality.) The excluded codes were either for services inappropriate for telemedicine (e.g., surgery) or those already covered by Medicare (e.g., telemedicine specialty consultations in primary care Health Professional Shortage Areas which are currently reimbursed). The included HCPCS codes represented radiologic or other procedures whose applicability fell under teletesting. Examples of this included G0030-G0047 (variants of cardiac PET imaging) and G104-G107 (variants of colon cancer screening).

Two individuals, a physician with expertise in internal medicine and medical informatics (WRH) and a nurse with expertise in emergency nursing and emergency department management (SES), reviewed all specified CPT and HCPCS codes for their suitability to self-monitoring/testing and clinician-interactive services. The reviewers examined the codes separately and then reconciled their differences. They required that the potential telemedicine application could involve a healthcare professional and utilize electronic data rather than audio telephone data exchange and/or an automated advice system. These individuals, involved in all facets of the evidence report described in the main body of the report, also sought to identify services provided that could not be adequately described by existing codes.

The first step in this analysis was to create broad categories of CPT codes (but less than a full chapter) to be able to characterize groups of services. Table 1 lists these categories of CPT code groups. Each line contains a range of codes for the clinical activity group. The final column denotes whether some or all of the codes were excluded from our analysis because services within them are already covered by Medicare as described above.

There were 171 CPT or HCPCS codes that could be applicable to self-monitoring/testing in the home or other remote sites (Table 2). Several CPT pathology codes were appropriate because there are portable units on the market that can perform various blood tests. These devices can measure chemistries, arterial blood gases, electrolytes, and other hematological parameters, and the number of physiological indicators that can be measured in the home is constantly increasing. Many of these measurements can be taken in a telecare program with the patient, a caregiver, or a health assistant collecting the data and transmitting it for analysis, and such procedures would be applicable for reimbursement. For our analysis, the list of codes was limited to those that represent what is currently being done in self-monitoring/testing practice. We did not identify any self-monitoring/testing services currently being provided that could not be represented by these codes.

There were 120 CPT codes that could be applicable to clinician-interactive services (Table 3). No HCPCS codes were applicable. Most of the CPT codes were Medicine and Evaluation & Management codes, representing a variety of services in which telemedicine could substitute for a face-to-face medical encounter. As with self-monitoring/testing telemedicine, we did not identify any clinician-interactive services currently being provided that could not be represented by these codes.

We conclude that current CPT and HCPCS codes are adequate for describing the types of telemedicine services covered by the study areas of this report. Modifiers will be needed to all separation of telemedicine and non-telemedicine services when utilization is being measured from claims databases.

Table A-1. Categories of CPT codes and their exclusion from the analysis

RangeCategorySection of CPT code definitionCodes excluded from review by contract
00100-01999AnesthesiaAnesthesiaAll
10000-69990Surgical or invasive diagnostic or therapeutic procedureSurgeryAll
70000-79999Radiologic or other imaging procedureRadiologySome
80049-87999Blood or urine fluid assessmentPathology
88000-88099AutopsyPathology
88104-88199CytopathologyPathology
88230-88241Tissue culturePathology
88245-88299CytogeneticsPathology
88300-88399Surgical pathologyPathology
89050-89359Assessment of other body fluidsPathology
90281-90799Diagnostic or therapeutic injectionMedicineAll
90801-90911PsychotherapyMedicineSome
90918-90999ESRD servicesMedicine
91000-91299Gastroenterology proceduresMedicine
92002-92499Opthalmologic proceduresMedicineSome
92502-92599Otolaryngolic proceduresMedicineSome
92950-93990Cardiovascular proceduresMedicine
94010-94799Pulmonary proceduresMedicine
95004-95199Allergy and immunologic proceduresMedicine
95805-95830Sleep studiesMedicine
95831-95999ElectrophysiologyMedicine
96100-96117Psychological testingMedicine
96400-96549ChemotherapyMedicine
96900-96999PhototherapyMedicine
97000-97799Physical therapyMedicine
98925-98943Manipulative therapyMedicine
99000-99082Special servicesMedicine
99090-99090Analysis of information stored in computersMedicine
99100-99199Anesthesia or sedationMedicineSome
99201-99215Outpatient visitE&M
99217-99239Inpatient visitE&M
99241-99245Office consultationE&MAll
99251-99263Inpatient consultationE&MAll
99271-99275Confirmatory consultationE&MAll
99281-99288Emergency department visitE&MAll
99291-99298Critical care visitE&M
99301-99333Nursing or domiciliary facility visitE&M
99341-99350Home visitE&M
99354-99359Prolonged physician evaluationE&MAll
99360-99373Management coordinationE&MAll
99374-99380Physician supervision of patient at home, hospice, or nursing facilityE&MAll
99381-99429Preventive medicine servicesE&MAll
99431-99440Newborn servicesE&MAll
99450-99499Disability evaluationE&MAll

Note: The CPT and HCPCS codes for inclusion were specified in our contract with the Agency for Healthcare Research and Quality.

Table A-2. Self-monitoring/testing HCPCS and CPT codes

RangeCategorySection
HCPCS
G0004ECG transm phys review & int
G0005ECG 24 hour recording
G0006ECG transmission & analysis
G0007ECG phy review & interpret
G0015Post symptom ECG tracing
G0016Post symptom ECG md review
G0108Diab manage trn per indiv
G0109Diab manage trn ind/group
CPT
80049-87999 Blood or urine fluid assessment Pathology
81000URINALYSIS, NONAUTO, W/SCOPE
81001URINALYSIS, AUTO, W/SCOPE
81002URINALYSIS, NONAUTO W/O SCOPE
81003URINALYSIS, AUTO, W/O SCOPE
81005URINALYSIS
81007URINE SCREEN FOR BACTERIA
81050URINALYSIS, VOLUME MEASURE
82270TEST FECES BLOOD
82273TEST BLOOD, OTHER SOURCE
82705FATS/LIPIDS, FECES QUALITATI
82947ASSAY QUANTITATIVE, GLUCOSE
82948REAGENT STRIP/BLOOD GLUCOSE
82962GLUCOSE BLOOD TEST
85013HEMATOCRIT
85610PROTHROMBIN TIME
90801-90911 Psychotherapy Medicine
90801PSYCH INTERVIEW, DIAGNOSTIC
90802PSYCH INTERVIEW, INTERACTIVE
90804PSYCH TX, OFFICE, 20-30 MIN
90805PSYCH TX, OFFICE, 20-30 MIN
90806PSYCH TX, OFFICE, 45-50 MIN
90807PSYCH TX, OFFICE, 45-50 MIN
90808PSYCH TX, OFFICE, 75-80 MIN
90809PSYCH TX, OFFICE, 75-80 MIN
90810PSYCH TX, OFFICE, 20-30 MIN
90811PSYCH TX, OFFICE, 20-30 MIN
90812PSYCH TX, OFFICE, 45-50 MIN
90813PSYCH TX, OFFICE, 45-50 MIN
90814PSYCH TX, OFFICE, 75-80 MIN
90815PSYCH TX, OFFICE, 75-80 MIN
90816PSYCH TX, HOSP, 20-30 MIN
90817PSYCH TX, HOSP, 20-30 MIN
90818PSYCH TX, HOSP, 45-50 MIN
90819PSYCH TX, HOSP, 45-50 MIN
90821PSYCH TX, HOSP, 75-80 MIN
90822PSYCH TX, HOSP, 75-80 MIN
90823PSYCH TX, HOSP, 20-30 MIN
90824PSYCH TX, HOSP, 20-30 MIN
90826PSYCH TX, HOSP, 45-50 MIN
90827PSYCH TX, HOSP, 45-50 MIN
90828PSYCH TX, HOSP, 75-80 MIN
90829PSYCH TX, HOSP, 75-80 MIN
90845PSYCHOANALYSIS
90846FAMILY THERAPY W/O PATIENT
90847FAMILY THERAPY W/PATIENT
90849MULT FAMILY GROUP THERAPY
90853GROUP PSYCHOTHERAPY
90857GROUP PSYCHOTHERAPY
90862MEDICATION MANAGEMENT
90901BIOFEEDBACK TRAIN, ANY METHD
90911BIOFEEDBACK PERI/URO/RECTAL
90918-90999 ESRD services Medicine
90918ESRD RELATED SERVICES, MONTH
90919ESRD RELATED SERVICES, MONTH
90920ESRD RELATED SERVICES, MONTH
90921ESRD RELATED SERVICES, MONTH
90922ESRD RELATED SERVICES, DAY
90923ESRD RELATED SERVICES, DAY
90924ESRD RELATED SERVICES, DAY
90925ESRD RELATED SERVICES, DAY
90989DIALYSIS TRAINING/COMPLETE
90993DIALYSIS TRAINING/INCOMPLETE
92502-92599 Otolaryngolic procedures Medicine
92506SPEECH/HEARING EVALUATION
92507SPEECH/HEARING THERAPY
92508SPEECH/HEARING THERAPY
92510REHAB FOR EAR IMPLANT
92950-93990 Cardiovascular procedures Medicine
93012TRANSMIT ECG
93014REPORT ON TRANSMITTED ECG
93224ECG MONITOR/REPORT, 24 HRS
93225ECG MONITOR/RECORD, 24 HRS
93226ECG MONITOR/REPORT, 24 HRS
93227ECG MONITOR/REVIEW, 24 HRS
93230ECG MONITOR/REPORT, 24 HRS
93231EXG MONITOR/RECORD, 24 HRS
93232ECG MONITOR/REPORT, 24 HRS
93233ECG MONITOR/REVIEW, 24 HRS
93235ECG MONITOR/REPORT, 24 HRS
93236ECG MONITOR/REPORT, 24 HRS
93237ECG MONITOR/REVIEW, 24 HRS
93268ECG RECORD/REVIEW
93270ECG RECORDING
93271ECG/MONITORING AND ANALYSIS
93272ECG/REVIEW, INTERPRET ONLY
93278ECG/SIGNAL-AVERAGED
93724ANALYZE PACEMAKER SYSTEM
93731ANALYZE PACEMAKER SYSTEM
93732ANALYZE PACEMAKER SYSTEM
93733TELEPHONE ANALYSIS PACEMAKER
93734ANALYZE PACEMAKER SYSTEM
93735ANALYZE PACEMAKER SYSTEM
93736TELEPHONE ANALYSIS PACEMAKER
93737ANALYZE CARDIO/DEFIBRILLATOR
93738ANALYZE CARDIO/DEFIBRILLATOR
93797CARDIAC REHAB
93798CARDIAC REHAB/MONITOR
94010-94799 Pulmonary procedures Medicine
94010BREATHING CAPACITY TEST
94014PATIENT RECORDED SPIROMETRY
94015PATIENT RECORDED SPIROMETRY
94016REVIEW PATIENT SPIROMETRY
94060EVALUATE WHEEZING
94070EVALUATE WHEEZING
94150VITAL CAPACITY TEST
94200LUNG FUNCTION TEST (MBC/MVV)
94240RESIDUAL LUNG CAPACITY
94660POS AIRWAY PRESSURE, CPAP
94662NEG PRESSURE VENTILATION, CN
94664AEROSOL/VAPOR INHALATIONS
94665AEROSOL/VAPOR INHALATIONS
94667CHEST WALL MANIPULATION
94668CHEST WALL MANIPULATION
94760MEASURE BLOOD OXYGEN LEVEL
94761 MEASURE BLOOD OXYGEN LEVEL
94762MEASURE BLOOD OXYGEN LEVEL
94770EXHALED CARBON DIOXIDE TEST
94772BREATH RECORDING INFANT
95805-95830 Sleep studies Medicine
95806SLEEP STUDY, UNATTENDED
96100-96117 Psychological testing Medicine
96100PSYCHOLOGICAL TESTING
96105ASSESS APHASIA
96110DEVELOPMENT TEST, LIMITED
96111DEVELOPMENT TEST, EXTENDED
96115NEUROBEHAVIOR STATUS EXAM
96117NEUROPYSCH TEST BATTERY
96900-96999 Phototherapy Medicine
96902TRICHOGRAM
97000-97799 Physical therapy Medicine
97001PT EVALUATION
97002PT RE-EVALUATION
97003OT EVALUATION
97004OT RE-EVALUATION
97010HOT/COLD PACKS THERAPY
97012MECHANICAL TRACTION THERAPY
97110THERAPEUTIC EXERCISES
97112NEUROMUSCULAR REEDUCATION
97113AQUATIC THERAPY/EXERCISES
97116GAIT TRAINING THERAPY
97124MASSAGE THERAPY
97139PHYSICAL MEDICINE PROCEDURE
97504ORTHOTIC TRAINING
97520PROSTHETIC TRAINING
97530THERAPEUTIC ACTIVITIES
97535SELF CARE MANAGMENT TRAINING
97537COMMUNITY/WORK REINTEGRATION
97542WHEELCHAIR MANAGMNT TRAINING
97545WORK HARDENING
97546WORK HARDENING ADD-ON
97703PROSTHETIC CHECKOUT
97750PHYSICAL PERFORMANCE TEST
97770COGNITIVE SKILLS DEVELOPMENT
97799PHYSICAL MEDICINE PROCEDURE
99301-99333 Nursing or domiciliary facility visit E&M
99321REST HOME VISIT NEW PATIENT
99322REST HOME VISIT NEW PATIENT
99323REST HOME VISIT NEW PATIENT
99331REST HOME VISIT EST PATIENT
99332REST HOME VISIT EST PATIENT
99333REST HOME VISIT EST PATIENT
99341-99350 Home visit E&M
99341HOME VISIT NEW PATIENT
99342HOME VISIT NEW PATIENT
99343HOME VISIT NEW PATIENT
99344HOME VISIT NEW PATIENT
99345HOME VISIT NEW PATIENT
99347HOME VISIT EST PATIENT
99348HOME VISIT EST PATIENT
99349HOME VISIT EST PATIENT
99350HOME VISIT EST PATIENT

Note: The CPT and HCPCS codes for inclusion were specified in our contract with the Agency for Healthcare Research and Quality.

Table A-3. Clinician-interactive services CPT codes

RangeCategorySection
80049-87999 Blood or urine fluid assessment Pathology
80500 LAB PATHOLOGY CONSULTATION
80502 LAB PATHOLOGY CONSULTATION
88300-88399 Surgical pathology Pathology
88321 MICROSLIDE CONSULTATION
88323 MICROSLIDE CONSULTATION
88325 COMPREHENSIVE REVIEW DATA
88329 PATHOLOGY CONSULT IN SURGERY
88331 PATHOLOGY CONSULT IN SURGERY
88332 PATHOLOGY CONSULT IN SURGERY
90801-90911 Psychotherapy Medicine
90801 PSYCH INTERVIEW, DIAGNOSTIC
90802 PSYCH INTERVIEW, INTERACTIVE
90804 PSYCH TX, OFFICE, 20-30 MIN
90805 PSYCH TX, OFFICE, 20-30 MIN
90806 PSYCH TX, OFFICE, 45-50 MIN
90807 PSYCH TX, OFFICE, 45-50 MIN
90808 PSYCH TX, OFFICE, 75-80 MIN
90809 PSYCH TX, OFFICE, 75-80 MIN
90810 PSYCH TX, OFFICE, 20-30 MIN
90811 PSYCH TX, OFFICE, 20-30 MIN
90812 PSYCH TX, OFFICE, 45-50 MIN
90813 PSYCH TX, OFFICE, 45-50 MIN
90814 PSYCH TX, OFFICE, 75-80 MIN
90815 PSYCH TX, OFFICE, 75-80 MIN
90816 PSYCH TX, HOSP, 20-30 MIN
90817 PSYCH TX, HOSP, 20-30 MIN
90818 PSYCH TX, HOSP, 45-50 MIN
90819 PSYCH TX, HOSP, 45-50 MIN
90821 PSYCH TX, HOSP, 75-80 MIN
90822 PSYCH TX, HOSP, 75-80 MIN
90823 PSYCH TX, HOSP, 20-30 MIN
90824 PSYCH TX, HOSP, 20-30 MIN
90826 PSYCH TX, HOSP, 45-50 MIN
90827 PSYCH TX, HOSP, 45-50 MIN
90828 PSYCH TX, HOSP, 75-80 MIN
90829 PSYCH TX, HOSP, 75-80 MIN
90845 PSYCHOANALYSIS
90846 FAMILY THERAPY W/O PATIENT
90847 FAMILY THERAPY W/PATIENT
90849 MULT FAMILY GROUP THERAPY
90853 GROUP PSYCHOTHERAPY
90857 GROUP PSYCHOTHERAPY
90862 MEDICATION MANAGEMENT
90901 BIOFEEDBACK TRAIN, ANY METHD
90911 BIOFEEDBACK PERI/URO/RECTAL
90918-90999 ESRD services Medicine
90918 ESRD RELATED SERVICES, MONTH
90919 ESRD RELATED SERVICES, MONTH
90920 ESRD RELATED SERVICES, MONTH
90921 ESRD RELATED SERVICES, MONTH
90922 ESRD RELATED SERVICES, DAY
90923 ESRD RELATED SERVICES, DAY
90924 ESRD RELATED SERVICES, DAY
90925 ESRD RELATED SERVICES, DAY
90989 DIALYSIS TRAINING/COMPLETE
90993 DIALYSIS TRAINING/INCOMPLETE
92002-92499 Opthalmologic procedures Medicine
92002 EYE EXAM NEW PATIENT
92004 EYE EXAM NEW PATIENT
92012 EYE EXAM EST PATIENT
92014 EYE EXAM W/TREATMENT
92502-92599 Otolaryngolic procedures Medicine
92506 SPEECH/HEARING EVALUATION
92507 SPEECH/HEARING THERAPY
92508 SPEECH/HEARING THERAPY
92510 REHAB FOR EAR IMPLANT
96100-96117 Psychological testing Medicine
96100 PSYCHOLOGICAL TESTING
96105 ASSESS APHASIA
96110 DEVELOPMENT TEST, LIMITED
96111 DEVELOPMENT TEST, EXTENDED
96115 NEUROBEHAVIOR STATUS EXAM
96117 NEUROPYSCH TEST BATTERY
96900-96999 Phototherapy Medicine
96902 TRICHOGRAM
97000-97799 Physical therapy Medicine
97001 PT EVALUATION
97002 PT RE-EVALUATION
97003 OT EVALUATION
97004 OT RE-EVALUATION
97010 HOT/COLD PACKS THERAPY
97012 MECHANICAL TRACTION THERAPY
97110 THERAPEUTIC EXERCISES
97112 NEUROMUSCULAR REEDUCATION
97113 AQUATIC THERAPY/EXERCISES
97116 GAIT TRAINING THERAPY
97124 MASSAGE THERAPY
97139 PHYSICAL MEDICINE PROCEDURE
97504 ORTHOTIC TRAINING
97520 PROSTHETIC TRAINING
97530 THERAPEUTIC ACTIVITIES
97535 SELF CARE MANAGMENT TRAINING
97537 COMMUNITY/WORK REINTEGRATION
97542 WHEELCHAIR MANAGMNT TRAINING
97545 WORK HARDENING
97546 WORK HARDENING ADD-ON
97703 PROSTHETIC CHECKOUT
97750 PHYSICAL PERFORMANCE TEST
97770 COGNITIVE SKILLS DEVELOPMENT
97799 PHYSICAL MEDICINE PROCEDURE
99201-99215 Outpatient visit E&M
99201 OFFICE VISIT NEW PATIENT
99202 OFFICE VISIT NEW PATIENT
99203 OFFICE VISIT NEW PATIENT
99204 OFFICE VISIT NEW PATIENT
99205 OFFICE VISIT NEW PATIENT
99211 OFFICE VISIT EST PATIENT
99212 OFFICE VISIT EST PATIENT
99213 OFFICE VISIT EST PATIENT
99214 OFFICE VISIT EST PATIENT
99215 OFFICE VISIT EST PATIENT
99301-99333 Nursing or domiciliary facility visit E&M
99321 REST HOME VISIT NEW PATIENT
99322 REST HOME VISIT NEW PATIENT
99323 REST HOME VISIT NEW PATIENT
99331 REST HOME VISIT EST PATIENT
99332 REST HOME VISIT EST PATIENT
99333 REST HOME VISIT EST PATIENT
99341-99350 Home visit E&M
99341 HOME VISIT NEW PATIENT
99342 HOME VISIT NEW PATIENT
99343 HOME VISIT NEW PATIENT
99344 HOME VISIT NEW PATIENT
99345 HOME VISIT NEW PATIENT
99347 HOME VISIT EST PATIENT
99348 HOME VISIT EST PATIENT
99349 HOME VISIT EST PATIENT
99350 HOME VISIT EST PATIENT

Note: The CPT and HCPCS codes for inclusion were specified in our contract with the Agency for Healthcare Research and Quality.

References

  1. Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) [PMC free article: PMC92788]
  2. American Medical Association Common Procedural Terminology (CPT) 1999 Edition. [PMC free article: PMC166167]

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