Effective April 1, 2020, the Georgia State Board of Workers’
Compensation (SBWC) is providing guidance for the provision of select services
via telemedicine during the COVID-19 pandemic. The national and state health
guidelines for limiting COVID-19 exposure recommend social distancing and
avoiding all but essential public contact. Therefore, telemedicine is
encouraged as a way to protect injured workers and healthcare providers from
exposure to the coronavirus during medical appointments that do not require
emergency treatment at a time when the health care system is over-extended.
The guidance regarding telemedicine is subject to change at any time at
the discretion of the SBWC. Reimbursement rates for telemedicine services prior
to April 1, 2020, should be negotiated between the parties. For negotiation
assistance, refer to the reimbursement rates in the 2019 Medical Fee Schedule
that were in effect on the date of service.
The procedure codes listed below are eligible to be provided via
telemedicine if the patient is non-emergent and when the healthcare provider
and the patient agree to the medical appointment being handled via
telemedicine. These procedure codes are designated with a in the Georgia Medical
Fee Schedule. The maximum allowable reimbursement for telemedicine services
shall be the lesser of billed charges or the professional maximum allowable
reimbursement (PROF MAR) amount as listed in the fee schedule.
Modifier 95
should be appended when reporting services provided via telemedicine. See page
11.
95 Synchronous Telemedicine Service Rendered Via a Real-Time Interactive
Audio and Video
Telecommunications
System
Synchronous telemedicine service is defined as a real-time interaction
between a physician or other qualified health care professional and a patient
who is located at a distant site from the physician or other qualified health
care professional. The totality of the communication of information exchanged
between the physician or other qualified health care professional and the
patient during the course of the synchronous telemedicine service must be of an
amount and nature that would be sufficient to meet the key components and/or
requirements of the same service when rendered via a face-to-face interaction.
Modifier 95 may only be appended to the services listed in Appendix P of CPT
2020. Appendix P is the list of CPT codes for services that are typically performed
face-to-face, but may be rendered via a real-time (synchronous) interactive
audio and video telecommunications system.
Evaluation
and Management Services
CPT Code | Description |
99201 | OFFICE OUTPATIENT NEW 10 MINUTES |
99202 | OFFICE OUTPATIENT NEW 20 MINUTES |
99203 | OFFICE OUTPATIENT NEW 30 MINUTES |
99204 | OFFICE OUTPATIENT NEW 45 MINUTES |
99205 | OFFICE OUTPATIENT NEW 60 MINUTES |
99211 | OFFICE OUTPATIENT VISIT 5 MINUTES |
99212 | OFFICE OUTPATIENT VISIT 10 MINUTES |
99213 | OFFICE OUTPATIENT VISIT 15 MINUTES |
99214 | OFFICE OUTPATIENT VISIT 25 MINUTES |
99215 | OFFICE OUTPATIENT VISIT 40 MINUTES |
99231 | SBSQ HOSPITAL CARE/DAY 15 MINUTES |
99232 |
SBSQ HOSPITAL CARE/DAY 25 MINUTES |
99233 | SBSQ HOSPITAL CARE/DAY 35 MINUTES |
99241 | OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN |
99242 |
OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN |
99243 | OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN |
99244 | OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN |
99245 | OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN |
99251 | INITIAL INPATIENT CONSULT NEW/ESTAB PT 20 MIN |
99252 | INITIAL INPATIENT CONSULT NEW/ESTAB PT 40 MIN |
99253 | INITIAL INPATIENT CONSULT NEW/ESTAB PT 55 MIN |
99254 | INITIAL INPATIENT CONSULT NEW/ESTAB PT 80 MIN |
99255 | INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN |
99307 | SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN |
99308 | SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN |
99309 |
SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN |
99310 | SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 35 MIN |
99354 | PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON 1ST HR |
99355 |
PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON ADDL 30 |
99406 | TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES |
99407 | TOBACCO USE CESSATION INTENSIVE >10 MINUTES |
99408 |
ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN |
99409 | ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN |
99495 | TRANSITIONAL CARE MANAGE SRVC 14 DAY DISCHARGE |
99496 | TRANSITIONAL CARE MANAGE SRVC 7 DAY DISCHARGE |
Physical Therapy, Occupational Therapy and
Speech Therapy Services
CPT Code | Description |
92521 | EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER) |
92522 | EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE |
92523 | EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION |
92524 | BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE |
96105 |
ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR |
97161 | PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS |
97162 | PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS |
97163 | PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS |
97164 | PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS |
97165 | OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS |
CPT Code | Description |
97166 |
OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS |
97167 |
OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS |
97168 |
OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS |
General Medicine
Services
CPT Code | Description |
90791 |
PSYCHIATRIC DIAGNOSTIC EVALUATION |
90792 |
PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES |
90832 |
PSYCHOTHERAPY W/PATIENT 30 MINUTES |
90833 |
PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN |
90834 | PSYCHOTHERAPY W/PATIENT 45 MINUTES |
90836 |
PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN |
90837 |
PSYCHOTHERAPY W/PATIENT 60 MINUTES |
90838 |
PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN |
90845 | PSYCHOANALYSIS |
90846 |
FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS |
90847 |
FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS |
90863 |
PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY |
96040 |
MEDICAL GENETICS COUNSELING EACH 30 MINUTES |
96116 |
NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR |
96156 |
HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT |
96158 |
HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN |
96159 |
HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN |
97802 |
MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI |
97803 |
MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M |
97804 | MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI |
98960 |
EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT |
98961 |
EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS |
98962 |
EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS |
CPT ©
2019 American Medical Association. All Rights Reserved.