New codes for 2013 Medicare telehealth

By Gary Capistrant posted 11-07-2012 17:06:17


In final rulemaking for the 2013 Medicare Part B physician fee schedule, the Centers for Medicare and Medicaid Services (CMS) have approved adding telehealth coverage for the following Healthcare Common Procedure Coding System (HCPCS) codes--

  • G0396 and G0397 -- Alcohol and/or substance (other than tobacco) abuse structured assessment (for example, AUDIT, DAST) and brief intervention, 15 to 30 minutes and intervention greater than 30 minutes, respectively.
  • G0442 -- Annual alcohol misuse screening, 15 minutes
  • G0443 -- Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
  • G0444 -- Annual depression screening, 15 minutes
  • G0445 -- High-intensity behavioral counseling to prevent sexually transmitted infections, face-to-face, individual, includes: education, skills training, and guidance on how to change sexual behavior, performed semiannually, 30 minutes
  • G0446 -- Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
  • G0447 -- Face-to-face behavioral counseling for obesity, 15 minutes

Also, CMS approved a technical correction regarding emergency department telehealth consultations.  In the 2012 fee schedule, they changed the code descriptors for initial inpatient telehealth consultation G-codes to reflect telehealth consultations furnished to emergency department patients in addition to inpatient telehealth consultations.  For 2013, they will institute a conforming change to amend the description of the services within the regulation at 42 CFR 414.65(a)(1)(i).

The full 1362-page notice of proposed rulemaking is available here.  An excerpt of the core 16 pages for telehealth is available here.  The final rulemaking will be published in the Federal Register on November 16.