Tele-Health Consultation

Beginning this past January there were 4 new CPT codes introduced for the billing of telephone/internet consultations.

  • If the consultation lasts longer than five minutes, and if the primary purpose of the consultation is more than simply arranging a transfer, one of these 4 codes can now be used for billing.

If prior history is any indication, just because a CPT code now exists, this doesn’t necessarily mean that payors will actually pay for the service.

The question I pose is.

  • As we move toward our new world of value and reducing the per member per month (PMPM) cost of care just because you can bill, should you bill? ¬†Will the cost/hassle of collecting demographic and insurance information outweigh the financial benefit?
  • If you don’t bill in this situation, does it constitute some form of kickback?
  • If you do happen to drop a bill, are you disadvantaging your outreach relationship? ¬†This would certainly be the case if the industry norm is “not to bill” and if your system we the only one billing for tele-consults.
  • I wonder if there is any formal legal interpretations on the above that has or will necessarily impact how systems in the United States conduct and bill for telephone and internet consults?