Adelfi Medical Billing Solutions

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New Telehealth Coding Updates: These changes are designed to streamline the documentation process and ensure accurate reimbursement for telehealth services. New CPT Codes: Audio/Video: New Patient - 98000, 98001, 98002, 98003 Established Patient - 98004, 98005, 98006, 98007 Audio only: New Patient - 98008, 98009, 98010, 98011 Established Patient - 98012, 98013, 98014, 98015 We have confirmed that Aetna is processing these new codes. *It is important to note that Traditional Medicare and United Healthcare do not recognize these codes.?For visits with these payers, the appropriate codes would be: Telehealth - Audio/Video: E/M code 99212-99215, 99202-99205 - Use POS 10 with modifier 95 Telehealth - Audio only: E/M code 99212-99215, 99202-99205 - Use POS 10 with modifier 93 We will be closely monitoring the processing of these claims to determine if there are any other payers that may not recognize the new codes.

NJ FamilyCare Behavioral Health Integration: Effective January 1, 2025

Aetna-NP Reimbursement Update: Effective April 1, 2025

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Telehealth in 2025-Medicare Medicare reinstates certain pre-pandemic telehealth policies. COVID-19 public health emergency waivers that applied to Medicare Part B policies for telehealth services ended May of 2023, and an extension of those waivers, granted in the Consolidated Appropriations Act, 2023, ends Dec.31, 2024. With that date rapidly approaching, the healthcare industry has been anxiously waiting for word from the Centers for Medicare & Medicaid Services (CMS) on the future of telehealth. That time has come. CMS issued the calendar year 2025 Physician Fee Schedule (PFS) final rule on Nov. 1, 2024, answering many questions circling in stakeholders’ heads. Absent Congressional action, this is the final word for telehealth services effective Jan. 1,2025. https://lnkd.in/ezy4y3zQ https://lnkd.in/d5J9nRgd https://lnkd.in/eQ3ktHya CMS acknowledges the CPT Editorial Panel’s decision to delete audio-only telephone services CPT codes 99441-99443 for 2025. However, Medicare will not recognize 16 of the 17 telehealth CPT codes (98000-98016) added for 2025; CPT codes 98000-98015 will have an Invalid status. Medicare will only pay separately for brief virtual check-in encounter CPT code 98016 in lieu of HCPCS Level II code G2012, which CMS is deleting due to redundancy. Direct supervision through real-time audio and visual interactive telecommunications (not audio-only) will continue to be allowed on qualifying services. Certain behavioral and mental health services will be permanently offered under telehealth for Medicare patients beginning Jan. 1, 2025. Place of service (POS) codes will continue to have two telehealth designations: 02 Patient not in their home when telehealth services are rendered 10 Patient in their home when telehealth services are rendered. POS 10 will continue to be paid at the non-facility rate. CMS will continue to allow physicians to list their practice address, rather than their home address, when performing Medicare services via telehealth from their home. Pre-pandemic geographic and location restrictions for telehealth (before March 1, 2020) are being reinstated. This means that unless a Medicare patient lives or is located in a health professional shortage area, a rural census track, or a county outside of the metropolitan statistical area at the time of service they will not be covered for telehealth services.

UHC Medical Policy Update: Effective 02/01/2025 Effective for dates of service on or after Feb 1, 2025, UnitedHealthcare will align with The Centers for Medicare and Medicaid (CMS) by enhancing the existing CCI Editing Policy, Professional and Outpatient Hospital CCI Editing Policy, Facility to support claim line denials when there are two shoulder arthroscopic procedures performed on the same shoulder. ? In accordance with the CMS National Correct Coding Initiative (NCCI) CPT codes 29805-29828 Procedure to Procedure (PTP) edit, code pairs consisting of two codes describing two shoulder arthroscopy procedures performed on the same shoulder will not be considered for separate reimbursement regardless if the code is appended with an NCCI PTP associated modifier. This includes the use of modifier 59. ? PTP edit code pairs will be considered for separate reimbursement performed on opposite shoulders and when appended with an appropriate NCCI PTP associated modifier. ? There are three exceptions (which are described in Chapter IV, Section E (Arthroscopy), Subsection 7 of the NCCI Manual. The following CPT codes will be considered for separate reimbursement when submitted in addition to code 29823 if extensive debridement is completed in a different area of the same shoulder. o 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure) o 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair) o 29828 (Arthroscopy, shoulder, surgical; biceps tenodesis)