Telephone visits, e-visits and hosted visits

Applies to:

  • Commercial group HMO, EPO, POS and PPO plans
  • Commercial individual MyPriority® plans
  • Priority Health Choice plans (Medicaid and Healthy Michigan Plan)
  • Priority Health Medicare plans

Definition:

Priority Health reimburses, fee for service, for telephone visits, e-visits and hosted visits. The CPT manual defines billing and coding requirements for both the physician and the clinical staff* visit.

  • No modifier is necessary to bill these codes
  • Copay and deductible may apply

Medicare billing

An e-visit cannot be used as a substitute for an effective, ongoing doctor-patient relationship, but is supportive of that relationship and of efficient delivery of care.

  • An e-visit must be fully documented in the member's record by the provider who performed it.
  • The provider must share that documentation with the member's primary care provider and/or other plan provider specified by the member.

Medicaid and Healthy Michigan Plan billing

Refer to the Medicaid fee schedules to determine if telephone, e-visit or hosted visits are payable services.

Go to Medicaid Fee Schedules

Reimbursement rates

The reimbursement rates for these codes are listed in our standard fee schedules for your contract.

See our standard fee schedules

Visit codes billable by physicians only

Hosted visits

A "hosted" visit is a virtual consult with a remote physician, hosted by a physician who is face-to-face with the patient. Telephone, teleconference, REMEC and other systems may be used.

  • G0406, Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth
  • G0407, Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth
  • G0408, Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth
  • G0425, Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth
  • G0426, Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth
  • G0427, Telehealth consultation, emergency department or initial inpatient, typically 70 minutes communicating with the patient via telehealth

Visit codes billable by physicians and clinical staff*

Online medical evaluations ("e-visits")

  • 99421, Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
  • 99422, Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
  • 99423, Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
  • G2010, Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment
  • 98016, Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion.

Visit codes billable by clinical staff*

Telephone assessment codes are not billable for Medigap plans.

  • 98966, Telephone assessment and management service provided by a qualified non-physician health care professional* to an established patient, parent or guardian; 5-10 minutes of medical discussion
  • 98967, Telephone assessment (see above), 11-20 minutes of medical discussion
  • 98968, Telephone assessment (see above), 21-30 minutes of medical discussion
  • 98970, Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
  • 98971, Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
  • 98972, Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

Also see Care management billing for details on the unique processing of clinical staff telephone visit codes.

*A clinical staff member is a person who works under the supervision of a physician, NP or PA and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service but who doesn’t individually report that professional service.