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.