MLN Matters® Number: MM6458
Related Change Request (CR) #: 6458
Related CR Release Date: April 24, 2009
Effective Date: January 1, 2009
Related CR Transmittal #: R105BP and R1716CP
Implementation Date: May 26, 2009
Provider Types Affected
Hospitals, provider-based renal dialysis facilities, physicians, and practitioners who bill Palmetto GBA for End Stage Renal Disease (ESRD)-related Medicare telehealth services
Provider Action Needed: Impact to You
This article is based on Change Request (CR) 6458, which updates the list of Medicare telehealth services to reflect the coding changes for ESRD-related services that took effect during the 2009 Healthcare Procedural Coding System (HCPCS) update.
What You Need to Know
The list of approved telehealth services is updated to reflect the deletion of the ESRD-related G-codes and the addition of the CPT codes. The established policy for telehealth services has not changed.
What You Need to Do
You should use the updated codes and advise your billing staff of the coding changes.
Background
The 2009 HCPCS update added several new Current Procedural Terminology (CPT) procedure codes related to ESRD services and deleted the related G-codes, effective for dates of service on or after January 1, 2009. A number of these ESRD-related services are on the list of approved telehealth services. The list of approved telehealth services has been updated to reflect the deletion of the G-codes and the addition of the CPT codes. The established policy for telehealth services has not changed.
Code Changes
- Effective January 1, 2009, Palmetto GBA will pay for CPT codes 90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961 according to the appropriate physician or practitioner fee schedule amount when submitted with a GT or GQ HCPCS modifier
- Effective January 1, 2009, Palmetto GBA will pay for CPT codes 90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961 according to the appropriate physician or practitioner fee schedule amount when submitted with a GT or GQ modifier by critical access hospitals that have elected Method II on Type of Bill 85X
Note: Contractors do not have to search their files and reprocess claims for CPT codes 90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961 with dates of service on or after January 1, 2009, but will adjust any claims for these services that you bring to their attention.
Additional Information
If you have questions, please contact our Provider Contact Center at our toll-free number (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.