2019 MPFS: Prolonged Preventive Service Codes May Make It On to Telehealth List

Medicare telehealth services

If telehealth is on your radar, you’ll want to watch the Medicare Physician Fee Schedule for 2019. The MPFS 2019 proposed rule discusses potential changes to Medicare telehealth services, specifically the addition of G0513 and G0514 to the Medicare telehealth list. Get a closer look at these codes so you’ll better understand them and the criteria for getting on to Medicare’s telehealth services list.

Tip: If you want more information on what’s in the MPFS proposed rule, check out our blog on potential E/M payment changes.

Pick G0513 and G0514 for Prolonged Preventive Services

Here are the codes CMS proposes to add to the Medicare telehealth list in 2019:

  • G0513 (Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service))
  • G0514 (… each additional 30 minutes (list separately in addition to code G0513 for additional 30 minutes of preventive service)).

These codes apply to prolonged preventive services. Note that both descriptors include the phrase “list separately in addition to code …,” which makes them add-on codes. The descriptor for G0514 makes it clear that the primary code for G0514 is G0513. For G0513 primary codes, check out the next section.

Compare Medicare Add-On Code Edits to Medicare Telehealth Code List

For 2018, Medicare Add-On Code Edits list the following codes as Type I primary codes for G0513:

  • Abdominal aortic aneurysm ultrasound screening: 76706
  • Bone density study: 76977, 77078, 77080, 77081, G0130
  • Breast screening: 77063, 77067
  • Female pelvic and breast exam: G0101
  • Pap smear: Q0091
  • Colorectal cancer screening: G0104, G0105, G0121
  • Lung cancer screening: G0296, G0297
  • Initial preventive physical exam: G0402
  • Annual wellness visit: G0438, G0439

For Add-On Code Edits, Type I means that the CPT® manual, HCPCS manual, and/or CMS policy defines all appropriate primary codes.

Narrow the list: Of the codes above, Medicare’s covered telehealth services list includes these codes:

  • G0296 (Counseling visit to discuss need for lung cancer screening (LDCT) using low dose CT scan (service is for eligibility determination and shared decision making))
  • G0438 (Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit)
  • G0439 (Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit).

That means G0296, G0438, and G0439 are Medicare telehealth services and appropriate primary codes for G0513 and G0514 (which are likely to be Medicare telehealth services in 2019).

Remember: The add-on and telehealth lists we’ve used here provide 2018 information. If the plan to add G0513 and G0514 to the telehealth list becomes reality for 2019, be sure you’re using Medicare’s 2019 lists for add-on code edits and telehealth services to understand what Medicare considers accurate coding and which services Medicare covers for telehealth for 2019 dates of service.

How Did G0513 and G0514 Get Approved?

The proposed MPFS 2019 rule states that CMS staff found G0513 and G0514 services “sufficiently similar to office visits currently on the telehealth list. We believe that all the components of this service can be furnished via interactive telecommunications technology.”

Another factor was that because some of the primary codes are telehealth codes, adding G0513 and G0514 to the list makes it easier for providers to report the primary preventive service code and the add-on code with the same place of service.

What About You?

What changes would you like to see to Medicare’s telehealth program? Would you like to see restrictions lightened?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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