New Medicare Codes for Telehealth, CLIA

Here are some new, revised, discontinued, and otherwise changed codes you may need to file Medicare claims in 2013.

Telehealth Service Changes 

The Centers for Medicare & Medicaid Services (CMS) has added eight services to its list of Medicare telehealth services (PDF), reported by HCPCS codes G0396 and G0397, and codes G0442-G0447.

In addition, the following CPT codes were added to replace those deleted for 2013:

  • CPT codes 90832, 90833, 90834, 90836, 90837, 90838 to report individual psychotherapy services (reported with CPT codes 90804-90809 prior to 2013); and
  • CPT codes 90791 and 90792 to report psychiatric diagnostic interview examination (reported with CPT code 90801 prior to 2013).

Also, CMS’ MLN Matters No. MM7900 (PDF) reports HCPCS code G0459 was added to the list of Medicare telehealth services for 2013 to allow telehealth services previously reported by CPT code 90862 to inpatients to continue to be reported. The effective date of this change was Jan. 1, and the implementation date was Jan. 25, 2013. (Note that as of Feb. 22, this HCPCS code had not yet been added to the list referenced above, which is dated December 2012.)

CLIA-Related Changes 

CMS has released a list (PDF) of new HCPCS codes for 2013 that are both subject to and excluded from Clinical Laboratory Improvement Amendments (CLIA) edits. Also provided is a list HCPCS codes discontinued as of Dec. 31, 2012.

Make sure that your billing staff is aware of these CLIA-related changes for 2013 and that you remain current with CLIA certification requirements. You can find useful CLIA-related links on the TMA website.

Published Feb. 26, 2013 


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