Resolved Level of service

[MistyR_46049]

Hello, for office visits and TLH 2024 I cannot locate what the highest level of service they can bill. One had said a level 2 is as high as they can bill but I cannot find anything that says that.

 

[Darcy]

Hello, for office visits and TLH 2024 I cannot locate what the highest level of service they can bill. One had said a level 2 is as high as they can bill but I cannot find anything that says that.

TLH??

 

[MistyR_46049]

TLH??

Sorry, telehealth, and office visits

 

[Alicia]

Telehealth is based on time and MDM like the other E/M codes. Is it audio only or video.

Non-Face-to-Face Services​

Online Digital Evaluation and Management Services​

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

99441Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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; 5-10 minutes of medical discussion
99442 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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; 11-20 minutes of medical discussion
99443 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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; 21-30 minutes of medical discussion

 

[MistyR_46049]

Telehealth is based on time and MDM like the other E/M codes. Is it audio only or video.

Non-Face-to-Face Services​

Online Digital Evaluation and Management Services​

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

99441Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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; 5-10 minutes of medical discussion
99442 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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; 11-20 minutes of medical discussion
99443 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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; 21-30 minutes of medical discussion

Yes, sorry I meant to ask if an APN can bill higher then a level 2 for telehealth and office I had one say they cannot bill higher then a level 2 however I could not locate that

 

[Alicia]

Yes they can. Any provider can bill the levels and an APN is considered a provider like an MD or DO. So you are good. Now, you might run into trouble "if" other providers are billing the same service on the same day.

 

[MistyR_46049]

Yes they can. Any provider can bill the levels and an APN is considered a provider like an MD or DO. So you are good. Now, you might run into trouble "if" other providers are billing the same service on the same day.

ok I thought they could but this one is saying they were told they couldnt bill higher then a level 2. If you have any document for that it be great thank you

 

[Alicia]

You can show the ANP the CMS APP fee schedule. For example Aetna is paying 85% of physicians rate- no restrictions on codes listed.
Maybe this ANP remembers when they were in a teaching program. Residents in a teaching program in clinic without teacher present can only bill level 3 or under. They have to use a GE modifer.