2021 CPT/HCPCS therapy update expands reimbursement for certain telehealth services

January 11, 2021
Medicare Web

CMS recently released MLN Matters MM12126, which summarizes 2021 CPT and HCPCS Level II code updates for Part B outpatient therapy services. The changes permanently expand Medicare coverage of certain communication technology-based (CTB) services, including virtual check-ins and telephone assessments. 

As noted in the update, in the 2021 Medicare Physician Fee Schedule (MPFS) final rule, CMS added 144 services to its list of physician telehealth services that will continue to be covered beyond the end of the COVID-19 public health emergency (PHE). The following HCPCS and CPT codes describe outpatient therapy services that, effective January 1, have been permanently added to the telehealth list (i.e., are no longer restricted by the effectiveness timeline of the PHE):  

  • HCPCS code G2250, remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous seven days nor leading to a service or procedure within the next 24 hours or soonest available appointment
  • HCPCS code G2251, brief communication technology-based service, (e.g., virtual check-in) by a qualified healthcare professional who cannot report E/M services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to a service or procedure within the next 24 hours or soonest available
  • CPT 98970, qualified nonphysician healthcare professional online digital E/M service, for an established patient, for up to seven days, cumulative time during the seven days; 5-10 minutes
  • CPT 98971, …; 11-20 minutes
  • CPT 98972, …; 21 or more minutes

The update also adds the following CPT codes for telephone assessment as “sometimes therapy” codes, effective for the duration of the PHE:

  • CPT 98966, telephone assessment and management service provided by a qualified nonphysician healthcare professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
  • CPT 98967, …; 11-20 minutes of medical discussion
  • CPT 98968 …; 21-30 minutes of medical discussion