CMS is processing telemedicine claims based on current guidance and your Medicare Administrative Contractor (MAC) may delay or require additional clarification to process telemedicine claims. Please reach out to your MAC for further guidance.
Teledermatology reimbursement rules are set by Medicare and individual private payers. The guidance below is on Medicare reimbursement.
The Academy has created a flowchart to help you identify and code teledermatology visits, along with a downloadable coding guide. Keep reading below for more guidance on how to use these documents.
The AAD has created a flowchart (PDF) to help you distinguish between and code these visits.
The AAD has created a coding guide (PDF) to help you code these visits.
Clinicians can provide remote evaluation of patient video/images and virtual check-in services (HCPCS codes G2010 and G2012 for physicians and G2251 and G2252 are for non-physician practitioners) to both new and established patients.
These services may only be provided to established patients.
Medicare telehealth services should all be reported with place of service (POS) code 11 and modifier 95 to indicate the encounter was performed via telehealth. These include CPT codes 99202 - 99215, 99421 - 99423, 99441 - 99443, 99446 - 99449, 99451 - 99452, G2010 - G2012.
Use the E/M service codes 99202 - 99215 to report a teledermatology synchronous service rendered via real-time two-way interactive audio and video that lasts longer than a virtual check-in (a virtual check-in lasts 5-10 minutes).
Medicare Telehealth Services List:
Medicare allows telephone-only encounters (CPT codes 99441 - 99443) to be reimbursed at the same rate as established patient E/M codes 99212 – 99214 until the end of 2023.
Updates on whether these services remain on the Medicare Telehealth Services List for 2024 and beyond will be addressed through established processes as part of the 2024 Medicare Physician Fee Schedule (MPFS) proposed and final rules.
The Consolidated Appropriations Act allows for all audio-only telehealth services for Medicare patients to be covered through December 31, 2024.
99441
99212
$56.93
99442
99213
$90.82
99443
99214
$128.43
CMS has temporarily modified the regulatory definition of direct supervision, which requires the supervising dermatologist or non-physician clinician to be “immediately available” to furnish assistance and direction during the service, to include “virtual presence” of the supervising dermatologist through the use of real-time audio and video technology. Per the 2024 MPFS Final rule, CMS will continue to allow direct supervision by a supervising practitioner through real-time audio and video interaction telecommunications through 2024.
Teaching physicians can supervise up to four residents via audio/video real-time technology. Teaching physicians must be present during the key portion of the furnished service; virtual supervision satisfies this requirement. Teaching physicians can review the services provided with the resident during, or immediately after the visit through telecommunications. This policy does not apply in the case of surgical, high risk, interventional, or other complex procedures, services performed through an endoscope, and anesthesia services.
Per the 2024 MPFS Final rule, CMS will continue to allow teaching physicians to use audio/visual real-time communication technology to be present when the resident furnishes Medicare telehealth services in all residency training locations through the end of 2024; teaching physicians and residents do not have to be co-located.
CMS modified the 60-day limit to allow dermatologists to use the same substitute billing arrangements for the entire time they are unavailable to provide services, plus an additional period of no more than 60 continuous days after the PHE expires.
The substitute billing arrangement rule will require the regular dermatologist to use a different substitute or return to work in their practice for at least 1 day in order to reset the 60-day clock. The modified timetable applies to both types of substitute billing arrangements under Medicare fee-for-service (i.e., reciprocal billing arrangements and fee-for-time compensation arrangements, formerly known as locum tenens).
We encourage practices to check with private payers before providing the service to ensure appropriate reimbursement expectations.
See regularly updated coverage of coding requirements that impact dermatologists.
Access Academy resources on private payers, including a tool that generates appeal letters.
See the Academy's coding resource center, organized around the subjects dermatologists need.