HCPCS 2019: Get to Know New Code G2012 for Virtual Check-In

Payment for non-face-to-face communication with patients isn’t the most clear-cut topic. But with new 2019 HCPCS code G2012, you’ve got an intriguing option for virtual check-ins with Medicare patients. Ready to learn more?

Dig In to the Long Descriptor for G2012

The first place to learn about the code is the long code descriptor:

  • G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion).

If that format is too dense, here are the bullet points for what’s in the G2012 descriptor:

  • The service is communication technology-based
  • The provider can be a physician or other qualified health care professional who reports E/M services
  • The patient must be an established patient
  • The communication can’t be related to an E/M service from within the previous seven days
  • The communication can’t lead to an E/M service within 24 hours (or soonest available)
  • The code represents five to 10 minutes of medical discussion.

Learn More From the MPFS Final Rule

The 2019 Medicare Physician Fee Schedule lists a national facility payment rate of $13.33 and a non-facility payment rate of $14.78 for G2012.

Why is Medicare offering this new code and paying for it? In the MPFS 2019 final rule, CMS acknowledges changes in communication technology have changed patient/provider interactions and expectations. Code G2012 emerged to represent brief check-in services to evaluate whether a visit is needed. The final rule provides these additional details for the code:

  • CMS plans to monitor use, watching for things like whether frequency limitations are needed. Commenters noted that in areas like behavioral health, frequency limitations could hinder medically necessary virtual check-ins, such as for suicide prevention.
  • The service must be medically reasonable and necessary to warrant payment. Medicare isn’t requiring any service-specific documentation requirements, though.
  • CMS is allowing both audio-only real-time telephone interactions and synchronous, two-way audio interaction with video or other data transmission.
    • Remember that the interaction must be between the patient and billing practitioner, not clinical staff.
  • The medical record must document verbal consent from the patient for each billed service. Cost sharing applies, and the beneficiary co-payment isn’t waived.
  • The service is available only to established patients, defined as patients who have “received professional services from the physician or qualified health care professional or another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past 3 years.”
  • The language in the code descriptor states, “nor leading to an E/M service or procedure within the next 24 hours.” Consequently, Medicare will be watching for an uptick in appointments occurring 25 hours or so after the call. Do not game the system to get around the 24-hour limitation.

What About You?

Do you expect to use this new code G2012 in 2019? Would you prefer to have more details about documentation requirements?

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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