E-visit billing made simple: CPT codes, reimbursement, and compliance
Today’s physicians receive 57% more patient portal messages than they did prior to the pandemic, according to the American Medical Association. And while some of these messages pertain to simple inquiries and quick medication refill requests, others necessitate medical decision making and involve more provider time to respond. In fact, with greater reliance on patient portals, providers increasingly spend more time on work outside of traditional, in-person billable visits. The question is, should a medical practice bill for the latter? Technically, many payers permit e-visit billing; however, billing for medical advice through the patient portal is a decision that providers must think through carefully.
What is an e-visit?
An e-visit is a clinical interaction with an eligible provider that occurs through an online patient portal. While not every clinical interaction is billable, providers may engage in e-visit billing for established patient-initiated encounters that require some level of medical decision-making and at least five minutes of the provider’s time over a 7-day period. E-visits include patient portal messages as well as condition-based questionnaire exchanges. For example, a patient answers a pre-written questionnaire through the portal, and a physician uses that information to determine whether the patient has COVID-19 or the flu.
CPT codes for billing an e-visit
For e-visit billing, physicians may report one of the following CPT codes involving non-face-to-face, established patient-initiated communications through an online patient portal.:
99421—Online digital evaluation and management (E/M) service, 5-10 minutes
99422—Online digital E/M service, 11-20 minutes
99423—Online digital E/M service, greater than 21 minutes
Non-physician providers may report one of the following CPT codes:
G2061—Qualified nonphysician healthcare professional online digital E/M service, 5-10 minutes
G2062—Qualified nonphysician healthcare professional online digital E/M service, 11-20 minutes
G2063—Qualified nonphysician healthcare professional online digital E/M service, greater than 21 minutes
Reimbursement guidelines for e-visits
Medicare Part B and most major insurers have reimbursement policies that cover e-visit billing; however, providers should always consult each payer prior to billing to prevent unnecessary denials. Medicare pays, on average, $14.56 for CPT code 99421, $28.46 for CPT code 99422, and $44.96 for CPT code 99423.
Compliance and documentation requirements
E-visit billing is only for established patients and requires at least five minutes of a provider’s time over a seven-day period. This is cumulative time during the seven days. For compliant e-visit billing, providers should ensure clinical documentation that reflects the following:
Cumulative time for up to seven days
Description of services rendered
Medical decision making
Patient consent
Treatment plan
How to optimize e-visits
There are several ways in which providers can optimize e-visits for maximum effectiveness, including the following:
Address socioeconomic barriers to portal utilization. Examples include access to technology, digital and health literacy, available language interpretation services, cultural sensitivities, and financial constraints.
Explore artificial intelligence (AI). AI may be able to appropriately route messages and assist care teams in drafting responses.
Implement effective triage systems. When patient messages come through the portal, ensure someone (or a team of individuals) is ready to review and route them to providers, as needed.
Improve workflows. Make it easy for staff to easily convert e-visits to an in-person or synchronous telehealth visit as needed.
Provide patient education. While established patients must be the ones who initiate e-visits, there’s nothing precluding providers from educating patients on the availability of these services prior to patient initiation. E-visits are particularly helpful for routine check-ups, follow-up appointments, and minor health concerns. They’re also helpful for patients with physical difficulties and limitations as well as those with transportation barriers and those who have difficulty traveling due to geographical distance.
Streamline the documentation process. Use electronic time tracking to align with time-based e-visit billing requirements.
Special considerations for e-visit billing
Before launching an e-visit billing initiative, providers should consider the potential impact on patient satisfaction. Patients who are accustomed to using the patient portal for free may perceive e-visit billing as an unexpected cost. Others may hesitate to reach out because they don’t want to receive a bill. This lack of communication can potentially compromise the quality of care. It’s important for medical practices to proactively communicate why patients may receive a bill for portal services and explain the value these services bring to patient care.
In addition, providers must be mindful of ever-evolving telehealth flexibilities related to e-visits, a type of telehealth. Currently, those e-visit billing flexibilities are extended through Sept. 30 as part of a short-term government funding bill signed by President Donald Trump.
Leveraging e-visit billing to improve patient care
By proactively addressing e-visit billing challenges and promoting patient portal messaging as a valuable communication tool, medical practices can enhance patient engagement and deliver high-quality patient care. Learn how edgeMED’s patient portal can enhance e-visit billing efforts.
