Telemedicine Reimbursement Policy: Temporary Update
Effective Date:
March 1, 2020
EFFECTIVE IMMEDIATELY through at least 90 days after the end of the public health emergency and State of Emergency declared by the Governor, in an effort to connect members with their providers, Horizon NJ Health shall expand the use of telemedicine services, for participating providers, during the current public health emergency, COVID-19. Horizon NJ Health shall reimburse the following services in addition to the existing Telemedicine and Telehealth reimbursement policy:
The following are the telemedicine services that may be utilized during this public health emergency:
- Telephonic Services (Phone call with audio only)
- Telemedicine Services (Both synchronous audio and visual required)
- Online Patient Portal Communication (Patient initiated virtual check-in for established patients only)
For all telemedicine services rendered, the provider should bill as follows:
- Use place of service (POS) ‘02’
- Append modifier ‘95’ or ‘GT’
- Follow current coding guidelines set forth by the American Medical Association, Current Procedural Terminology Professional Edition and associated publications and services
Temporary extended telemedicine services includes: audiology/tinnitus assessments, behavioral health assessments, behavioral health counseling, behavioral health OBAT/MAT services, hearing aid checks (binaural and monaural), occupational therapy (OT) evaluations, physical therapy (PT) evaluations, self-management education services and speech therapy services. Review a list of the existing procedure codes allowed via telemedicine as well as the new extended codes.
The telemedicine site of origin guidelines will be waived during this public health emergency. Horizon NJ Health will not require a member and/or provider to go to a specific location to engage in telemedicine.
Telemedicine service provisions are limited to those services within a provider’s current scope of practice.
Authorization requirements are waived for telemedicine services during this temporary expansion.
Providers must maintain a complete and accurate record of all telemedicine services performed for Horizon NJ Health members in accordance with applicable law, rules and regulations, and Horizon NJ Health policies.
Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:
- Benefit limitations;
- The terms of any applicable provider participation agreement;
- Routine claim editing logic, including but not limited to incidental or mutually exclusive logic;
- Pertinent Horizon NJ Health reimbursement policies and/or medical policies;
- Applicable law, regulatory guidance, government mandates, and the terms of the Managed Care Contract between Horizon NJ Health and the New Jersey Department of Human Services, Division of Medical Assistance and Health Services.
References:
https://www.nj.gov/governor/news/news/562020/approved/20200322b.shtml
https://www.state.nj.us/dobi/bulletins/blt20_07.pdfht
American Medical Association, Current Procedural Terminology (CPT®) Professional Edition and associated publications and services
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on April 8, 2020
Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.
CPT? is a registered mark of the American Medical Association. 1
An Independent Licensee of the
Blue Cross and Blue Shield Association.
Code Service Description
Telemedicine
Reimbursement Policy
Position for HNJH
77427 Radiation treatment management, 5 treatments Extended
90791 Psychiatric diagnostic evaluation Existing
90792 Psychiatric diagnostic evaluation with medical services Existing
90832 Psychotherapy, 30 minutes with patient Existing
90833 Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (add-on code) Existing
90834 Psychotherapy, 45 minutes with patient Existing
90836 Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (add-on code) Existing
90837 Psychotherapy, 60 minutes with patient Existing
90838 Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (add-on code) Existing
90839 Psychotherapy for crisis; first 60 minutes Existing
90845 Psychoanalysis Existing
90846 Family psychotherapy (without the patient present), 50 minutes Existing
90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes Existing
90863 Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (add-on code) Existing
90951 Dialysis services (4 or more physician visits per month), patient younger than 2 years of age Existing
90952 Dialysis services (2-3 physician visits per month), patient younger than 2 years of age Existing
90954 Dialysis services (4 or more physician visits per month), patient 2-11 years of age Existing
90955 Dialysis services (2-3 physician visits per month), patient 2-11 years of age Existing
90957 Dialysis services (4 or more physician visits per month), patient 12-19 years of age Existing
90958 Dialysis services (2-3 physician visits per month), patient 12-19 years of age Existing
90960 Dialysis services (4 or more physician visits per month), patient 20 years of age and older Existing
90961 Dialysis services (2-3 physician visits per month), patient 20 years of age and older Existing
90963 Home dialysis services per month, patient younger than 2 years of age Existing
90964 Home dialysis services per month, patient 2-11 years of age Existing
90965 Home dialysis services per month, patient 12-19 years of age Existing
90966 Home dialysis services per month, patient 20 years of age or older Existing
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on April 8, 2020
Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.
CPT? is a registered mark of the American Medical Association. 2
An Independent Licensee of the
Blue Cross and Blue Shield Association.
Code Service Description
Telemedicine
Reimbursement Policy
Position for HNJH
90967 Dialysis services, per day (less than full month service), patient younger than 2 years of age Existing
90968 Dialysis services, per day (less than full month service), patient 2-11 years of age Existing
90969 Dialysis services, per day (less than full month service), patient 12-19 years of age Existing
90970 Dialysis services, per day (less than full month service), patient 20 years of age or older Existing
92507 Treatment Of Speech, Language, Voice, Communication, And/or Auditory Processing Disorder Extended
92520 Laryngeal function studies (ie, aerodynamic testing and acoustic testing) Extended
92521 Evaluation of speech fluency (eg, stuttering, cluttering) Extended
92522 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); Extended
92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) Extended
92524 Behavioral and qualitative analysis of voice and resonance Extended
92526 Treatment of swallowing dysfunction and/or oral function for feeding Extended
92592 Hearing aid check; monaural Extended
92593 Hearing aid check; binaural Extended
92610 Evaluation of oral and pharyngeal swallowing function Extended
92625 Assessment of tinnitus (includes pitch, loudness matching, and masking) Extended
96105 Assessment of expressive and receptive speech with interpretation and report per hour Extended
96116 Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes Existing
96130 Psychological testing evaluation by qualified health care professional, first 60 minutes Extended
96131 Psychological testing evaluation by qualified health care professional, additional 60 minutes Extended
96132 Neuropsychological testing evaluation services by physician or other qualified health care professional, first 60 minutes Extended
96133 Neuropsychological testing evaluation services by physician or other qualified health care professional, additional 60 minutes Extended
96136 Psychological or neuropsychological testing; first 30 minutes Extended
96137 Psychological or neuropsychological testing; additional 30 minutes Extended
96138 Psychological or neuropsychological test administration; first 30 minutes Extended
96139 Psychological or neuropsychological test administration; additional 30 minutes Extended
96160 Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument Existing
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on April 8, 2020
Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.
CPT? is a registered mark of the American Medical Association. 3
An Independent Licensee of the
Blue Cross and Blue Shield Association.
Code Service Description
Telemedicine
Reimbursement Policy
Position for HNJH
96161 Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument Existing
97110 Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility Extended
97112 Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes Extended
97116 Walking training to 1 or more areas, each 15 minutes Extended
97129 Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity, direct (one-on-one) patient contact; initial 15 minutes Extended
97130
Therapeutic interventions that focus on cognitive function and compensatory strategies to manage
the performance of an activity, direct (one-on-one) patient contact; each additional 15 minutes
(add-on code)
Extended
97151
Behavior identification assessment, administered by a physician or other qualified health care
professional, each 15 minutes of the physician's or other qualified health care professional's time
face-to-face with patient and/or guardian(s)/caregiver(s)
Extended
97152
Behavior identification-supporting assessment, administered by one technician under the direction
of a physician or other qualified health care professional, face-to-face with the patient, each 15
minutes
Extended
97153
Adaptive behavior treatment by protocol, administered by technician under the direction of a
physician or other qualified health care professional, face-to-face with one patient, each 15
minutes
Extended
97154
Group adaptive behavior treatment by protocol, administered by technician under the direction of
a physician or other qualified health care professional, face-to-face with two or more patients, each
15 minutes
Extended
97155
Adaptive behavior treatment with protocol modification, administered by physician or other
qualified health care professional, which may include simultaneous direction of technician, face-to-
face with one patient, each 15 minutes
Extended
97156
Family adaptive behavior treatment guidance, administered by physician or other qualified health
care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s),
each 15 minutes
Extended
97157
Multiple-family group adaptive behavior treatment guidance, administered by physician or other
qualified health care professional (without the patient present), face-to-face with multiple sets of
guardians/caregivers, each 15 minutes
Extended
97158 Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes Extended
97161 Evaluation of physical therapy, typically 20 minutes Extended
97162 Evaluation of physical therapy, typically 30 minutes Extended
97163 Evaluation of physical therapy, typically 45 minutes Extended
97164 Re-evaluation of physical therapy, typically 20 minutes Extended
97165 Evaluation of occupational therapy, typically 30 minutes Extended
97166 Evaluation of occupational therapy, typically 45 minutes Extended
97167 Evaluation of occupational therapy established plan of care, typically 60 minutes Extended
97168 Re-evaluation of occupational therapy established plan of care, typically 30 minutes Extended
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on April 8, 2020
Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.
CPT? is a registered mark of the American Medical Association. 4
An Independent Licensee of the
Blue Cross and Blue Shield Association.
Code Service Description
Telemedicine
Reimbursement Policy
Position for HNJH
97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes Extended
97535
Self-care/home management training and compensatory training, meal preparation, safety
procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-
on-one contact, each 15 minutes
Extended
97750 Physical performance test or measurement with report, each 15 minutes Extended
97755 Assistive technology assessment to enhance functional performance, each 15 minutes Extended
97760 Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes Extended
97761 Training in use of prosthesis for arms and/or legs, per 15 minutes Extended
97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes Existing
97803 Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes Existing
97804 Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes Existing
98960
Education and training for patient self-management by a qualified, nonphysician health care
professional using a standardized curriculum, face-to-face with the patient (could include
caregiver/family) each 30 minutes; individual patient
Extended
98961
Education and training for patient self-management by a qualified, nonphysician health care
professional using a standardized curriculum, face-to-face with the patient (could include
caregiver/family) each 30 minutes; 2-4 patients
Extended
98962
Education and training for patient self-management by a qualified, nonphysician health care
professional using a standardized curriculum, face-to-face with the patient (could include
caregiver/family) each 30 minutes; 5-8 patients
Extended
98966 Telephone assessment and management service, 5-10 minutes of medical discussion Extended
98967 Telephone assessment and management service, 11-20 minutes of medical discussion Extended
98968 Telephone assessment and management service, 21-30 minutes of medical discussion Extended
98970 Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes Extended
98971 Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes Extended
98972 Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes Extended
99201 New patient office or other outpatient visit, typically 10 minutes Existing
99202 New patient office or other outpatient visit, typically 20 minutes Existing
99203 New patient office or other outpatient visit, typically 30 minutes Existing
99204 New patient office or other outpatient visit, typically 45 minutes Existing
99205 New patient office or other outpatient visit, typically 60 minutes Existing
99211 Established patient office or other outpatient visit, typically 5 minutes Existing
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on April 8, 2020
Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.
CPT? is a registered mark of the American Medical Association. 5
An Independent Licensee of the
Blue Cross and Blue Shield Association.
Code Service Description
Telemedicine
Reimbursement Policy
Position for HNJH
99212 Established patient office or other outpatient visit, typically 10 minutes Existing
99213 Established patient office or other outpatient visit, typically 15 minutes Existing
99214 Established patient office or other outpatient, visit typically 25 minutes Existing
99215 Established patient office or other outpatient, visit typically 40 minutes Existing
99217 Hospital observation care on day of discharge Extended
99218 Hospital observation care, typically 30 minutes Extended
99219 Hospital observation care, typically 50 minutes Extended
99220 Hospital observation care, typically 70 minutes Extended
99221 Initial hospital inpatient care, typically 30 minutes per day Extended
99222 Initial hospital inpatient care, typically 50 minutes per day Extended
99223 Initial hospital inpatient care, typically 70 minutes per day Extended
99224 Subsequent observation care, typically 15 minutes per day Extended
99225 Subsequent observation care, typically 25 minutes per day Extended
99226 Subsequent observation care, typically 35 minutes per day Extended
99231 Subsequent hospital inpatient care, typically 15 minutes per day Existing
99232 Subsequent hospital inpatient care, typically 25 minutes per day Existing
99233 Subsequent hospital inpatient care, typically 35 minutes per day Existing
99234 Hospital observation or inpatient care low severity, 40 minutes per day Extended
99235 Hospital observation or inpatient care moderate severity, 50 minutes per day' Extended
99236 Hospital observation or inpatient care high severity, 55 minutes per day Extended
99238 Hospital discharge day management, 30 minutes or less Extended
99239 Hospital discharge day management, more than 30 minutes Extended
99241 Patient office consultation, typically 15 minutes Existing
99242 Patient office consultation, typically 30 minutes Existing
99243 Patient office consultation, typically 40 minutes Existing
99244 Patient office consultation, typically 60 minutes Existing
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on April 8, 2020
Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.
CPT? is a registered mark of the American Medical Association. 6
An Independent Licensee of the
Blue Cross and Blue Shield Association.
Code Service Description
Telemedicine
Reimbursement Policy
Position for HNJH
99245 Patient office consultation, typically 80 minutes Existing
99251 Inpatient hospital consultation, typically 20 minutes Existing
99252 Inpatient hospital consultation, typically 40 minutes Existing
99253 Inpatient hospital consultation, typically 55 minutes Existing
99254 Inpatient hospital consultation, typically 80 minutes Existing
99255 Inpatient hospital consultation, typically 110 minutes Existing
99281 Emergency department visit, self limited or minor problem Extended
99282 Emergency department visit, low to moderately severe problem Extended
99283 Emergency department visit, moderately severe problem Extended
99284 Emergency department visit, problem of high severity Extended
99285 Emergency department visit, problem with significant threat to life or function Extended
99291 Critical care delivery critically ill or injured patient, first 30-74 minutes Extended
99292 Critical care delivery critically ill or injured patient Extended
99304 Initial nursing facility visit, typically 25 minutes per day Extended
99305 Initial nursing facility visit, typically 35 minutes per day Extended
99306 Initial nursing facility visit, typically 45 minutes per day Extended
99307 Subsequent nursing facility visit, typically 10 minutes per day Existing
99308 Subsequent nursing facility visit, typically 15 minutes per day Existing
99309 Subsequent nursing facility visit, typically 25 minutes per day Existing
99310 Subsequent nursing facility visit, typically 35 minutes per day Existing
99315 Nursing facility discharge day management, 30 minutes or less Extended
99316 Nursing facility discharge management, more than 30 minutes Extended
99327 New patient assisted living visit, typically 60 minutes Extended
99328 New patient assisted living visit, typically 75 minutes Extended
99334 Established patient assisted living visit, typically 15 minutes Extended
99335 Established patient assisted living visit, typically 25 minutes Extended
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on April 8, 2020
Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.
CPT? is a registered mark of the American Medical Association. 7
An Independent Licensee of the
Blue Cross and Blue Shield Association.
Code Service Description
Telemedicine
Reimbursement Policy
Position for HNJH
99336 Established patient assisted living visit, typically 40 minutes Extended
99337 Established patient assisted living visit, typically 60 minutes Extended
99341 New patient home visit, typically 20 minutes Extended
99342 New patient home visit, typically 30 minutes Extended
99343 New patient home visit, typically 45 minutes Extended
99344 New patient home visit, typically 60 minutes Extended
99345 New patient home visit, typically 75 minutes Extended
99347 Established patient home visit, typically 15 minutes Extended
99348 Established patient home visit, typically 25 minutes Extended
99349 Established patient home visit, typically 40 minutes Extended
99350 Established patient home visit, typically 60 minutes Extended
99354 Prolonged office or other outpatient service first hour Existing
99355 Prolonged office or other outpatient service each 30 minutes beyond first hour Existing
99356 Prolonged inpatient or observation hospital service first hour Existing
99357 Prolonged inpatient or observation hospital service each 30 minutes beyond first hour Existing
99381 Initial new patient preventive medicine evaluation infant younger than 1 year Extended
99382 Initial new patient preventive medicine evaluation, age 1 through 4 years Extended
99383 Initial new patient preventive medicine evaluation, age 5 through 11 years Extended
99384 Initial new patient preventive medicine evaluation, age 12 through 17 years Extended
99385 Initial new patient preventive medicine evaluation age 18-39 years Extended
99386 Initial new patient preventive medicine evaluation age 40-64 years Extended
99387 Initial new patient preventive medicine evaluation, age 65 years and older Extended
99391 Established patient periodic preventive medicine examination infant younger than 1 year Extended
99392 Established patient periodic preventive medicine examination, age 1 through 4 years Extended
99393 Established patient periodic preventive medicine examination, age 5 through 11 years Extended
99394 Established patient periodic preventive medicine examination, age 12 through 17 years Extended
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on April 8, 2020
Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.
CPT? is a registered mark of the American Medical Association. 8
An Independent Licensee of the
Blue Cross and Blue Shield Association.
Code Service Description
Telemedicine
Reimbursement Policy
Position for HNJH
99395 Established patient periodic preventive medicine examination age 18-39 years Extended
99396 Established patient periodic preventive medicine examination age 40-64 years Extended
99397 Established patient periodic preventive medicine examination, age 65 years and older Extended
99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes Existing
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes Existing
99408 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes Existing
99409 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes Existing
99421 Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes Extended
99422 Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes Extended
99423 Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes Extended
99441 Physician telephone patient service, 5-10 minutes of medical discussion Extended
99442 Physician telephone patient service, 11-20 minutes of medical discussion Extended
99443 Physician telephone patient service, 21-30 minutes of medical discussion Extended
99468 Initial inpatient hospital critical care of newborn, 28 days of age or younger, per day Extended
99469 Subsequent inpatient hospital critical care of newborn, 28 days of age or younger, per day Extended
99471 Initial inpatient hospital critical care of infant or young child, 29 days through 24 months of age, per day Extended
99472 Subsequent inpatient hospital critical care of infant or young child, 29 days through 24 months of age, per day Extended
99475 Initial inpatient hospital critical care of infant or young child, 2 through 5 years of age, per day Extended
99476 Subsequent inpatient hospital critical care of infant or young child, 2 through 5 years of age, per day Extended
99477 Initial intensive care of newborn, 28 days of age or younger, per day Extended
99478 Subsequent intensive care of recovering low birth weight infant, per day Extended
99479 Subsequent intensive care of recovering low birth weight infant, per day Extended
99480 Subsequent intensive care of recovering low birth weight infant, per day Extended
99483 Assessment of and care planning for patient with impaired thought processing, typically 50 minutes Extended
99495 Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge Existing
99496 Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge Existing
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on April 8, 2020
Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.
CPT? is a registered mark of the American Medical Association. 9
An Independent Licensee of the
Blue Cross and Blue Shield Association.
Code Service Description
Telemedicine
Reimbursement Policy
Position for HNJH
99497 Advance care planning by the physician or other qualified health care professional Existing
99498 Advance care planning by the physician or other qualified health care professional (add-on code) Existing
0362T Behavior identification supporting assessment for patient exhibiting destructive behavior, each 15 minutes of technicians' face-to-face time Extended
0373T Adaptive behavior treatment with protocol modification for patient exhibiting destructive behavior, each 15 minutes of technicians' face-to-face time Extended
90887 HF Explanation of psychiatric, medical examinations, procedures, and data to other than patient; substance abuse program Extended
90887 UC Explanation of psychiatric, medical examinations, procedures, and data to other than patient; Medicaid level of care 12 Extended
G0108 Diabetes outpatient self-management training services, individual, per 30 minutes Existing
G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes Existing
G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen, each 15 minutes Existing
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) Existing
G0396 Alcohol and/or substance (other than tobacco) abuse structured assessment (eg, AUDIT, DAST). and brief intervention 15 to 30 minutes Existing
G0397 Alcohol and/or substance (other than tobacco) abuse structured assessment (eg, AUDIT, DAST). and intervention, greater than 30 minutes Existing
G0406 Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth Existing
G0407 Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth Existing
G0408 Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth Existing
G0420 Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour Existing
G0421 Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour Existing
G0425 Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth Existing
G0426 Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth Existing
G0427 Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth Existing
G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes Extended
G0445 High intensity behavioral counseling, 30 minutes Existing
G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes Existing
G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services (add-on code) Existing
G0508 Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth Existing
G0509 Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth Existing
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on April 8, 2020
Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.
CPT? is a registered mark of the American Medical Association. 10
An Independent Licensee of the
Blue Cross and Blue Shield Association.
Code Service Description
Telemedicine
Reimbursement Policy
Position for HNJH
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 (add-on code)
Existing
G0514
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; each
additional 30 minutes (add-on code)
Existing
G2010 Remote evaluation of recorded video and/or images submitted by an established patient Extended
G2012 Brief communication technology-based service, e.g., virtual check-in, 5-10 minutes of medical discussion Extended
G2061 Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes Extended
G2062 Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes Extended
G2063 Qualified nonphysician qualified health care professional assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes Extended
H0001 Alcohol and drug assessment Extended
H0002 Behavioral health screening to determine eligibility for admission to treatment program Extended
H0004 Behavioral health counseling and therapy, per 15 minutes Extended
H0006 HF Navigator services (Maintenance) Extended
H0006 HF HG Navigator psychosocial assessment & patient-specific Treatment plan development (Initiation) Extended
H0006 HF SU Navigator services (Stabilization) Extended
H0014 Alcohol and/or drug services; ambulatory detoxification Extended
H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) Extended
H0020 HF Methadone (per diem) Extended
H0020 HF 26 Methadone (bundled) Extended
H0032 Mental Health service plan development by a non-physician, per 15 minutes Extended
H0033 HF non-Methadone (per diem) Extended
H0033 HF 26 non-Methadone (bundled) Extended
H0035 Mental health partial hospitalization, treatment, less than 24 hours Extended
H0047 Alcohol and/or other drug abuse services, not otherwise specified Extended
H2036 HF Alcohol and/or other drug treatment program, per diem; substance abuse program Extended
Page | 1
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
77427 Radiation treatment management, 5 treatments Extended during PHE
90791 Psychiatric diagnostic evaluation In Existing Policy
90792 Psychiatric diagnostic evaluation with medical services In Existing Policy
90832 Psychotherapy, 30 minutes with patient In Existing Policy
90833 Psychotherapy, 30 minutes with patient when performed with an evaluation and management
service (add-on code)
In Existing Policy
90834 Psychotherapy, 45 minutes with patient In Existing Policy
90836 Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (add-on code) In Existing Policy
90837 Psychotherapy, 60 minutes with patient In Existing Policy
90838 Psychotherapy, 60 minutes with patient when performed with an evaluation and management
service (add-on code)
In Existing Policy
90839 Psychotherapy for crisis; first 60 minutes In Existing Policy
90840 Psychotherapy for crisis; each additional 30 minutes (add-on code) Extended during PHE
90846 Family psychotherapy (without the patient present), 50 minutes In Existing Policy
90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes In Existing Policy
90849 Multiple-family group psychotherapy Extended during PHE
90853 Group psychotherapy (other than of a multiple -family group) Extended during PHE
90863 Pharmacologic management, including prescription and review of medication, when
performed with psychotherapy services (add-on code)
In Existing Policy
90875 Psychophysiological therapy Extended during PHE
90951 Dialysis services (4 or more physician visits per month), patient younger than 2 years of age In Existing Policy
90952 Dialysis services (2-3 physician visits per month), patient younger than 2 years of age In Existing Policy
90953 Dialysis services (1 physician visit per month), patient younger than 2 years of age Extended during PHE
90954 Dialysis services (4 or more physician visits per month), patient 2-11 years of age In Existing Policy
90955 Dialysis services (2-3 physician visits per month), patient 2-11 years of age In Existing Policy
90956 Dialysis services (1 physician visit per month), patient 2-11 years of age Extended during PHE
90957 Dialysis services (4 or more physician visits per month), patient 12 -19 years of age In Existing Policy
90958 Dialysis services (2-3 physician visits per month), patient 12-19 years of age In Existing Policy
90959 Dialysis services (1 physician visit per month), patient 12-19 years of age Extended during PHE
90960 Dialysis services (4 or more physician visits per month), patient 20 years of age and older In Existing Policy
90961 Dialysis services (2-3 physician visits per month), patient 20 years of age and older In Existing Policy
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 2
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
90962 Dialysis services (1 physician visit per month), patient 20 years of age and older Extended during PHE
90963 Home dialysis services per month, patient younger than 2 years of age In Existing Policy
90964 Home dialysis services per month, patient 2-11 years of age In Existing Policy
90965 Home dialysis services per month, patient 12-19 years of age In Existing Policy
90966 Home dialysis services per month, patient 20 years of age or older In Existing Policy
90967 Dialysis services, per day (less than full month service), patient younger than 2 years of age In Existing Policy
90968 Dialysis services, per day (less than full month service), patient 2 -11 years of age In Existing Policy
90969 Dialysis services, per day (less than full month service), patient 12 -19 years of age In Existing Policy
90970 Dialysis services, per day (less than full month service), patient 20 years of age or older In Existing Policy
92002 Eye and medical examination for diagnosis and treatment, new patient Extended during PHE
92004 Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits Extended during PHE
92012 Eye and medical examination for diagnosis and treatment, established patient Extended during PHE
92014 Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits Extended during PHE
92227 Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes)
with analysis and report under physician supervision, unilateral or bilateral
Extended during PHE
92228 Remote imaging for monitoring and management of active retinal disease (eg, diabetic
retinopathy) with physician review, interpretation and report, unilateral or bilateral
Extended during PHE
92507 Treatment Of Speech, Language, Voice, Communication, And/or Auditory Processing Disorder Extended during PHE
92508
Treatment of speech, language, voice, communication, and/or auditory processing disorder;
group, 2 or more individuals Extended during PHE
92520 Laryngeal function studies (ie, aerodynamic testing and acoustic testing) Extended during PHE
92521 Evaluation of speech fluency (eg, stuttering, cluttering) Extended during PHE
92522
Evaluation of speech sound production (eg, articulation, phonological process, apraxia,
dysarthria); Extended during PHE
92523
Evaluation of speech sound production (eg, articulation, phonological process, apraxia,
dysarthria); with evaluation of language comprehension and expression (eg, receptive and
expressive language)
Extended during PHE
92524 Behavioral and qualitative analysis of voice and resonance Extended during PHE
92526 Treatment of swallowing dysfunction and/or oral function for feeding Extended during PHE
92592 Hearing aid check; monaural Extended during PHE
92593 Hearing aid check; binaural Extended during PHE
92601 Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming Extended during PHE
92602
Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent
reprogramming Extended during PHE
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 3
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
92603 Diagnostic analysis of cochlear implant, age 7 years or older; with programming Extended during PHE
92604 Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming Extended during PHE
92610 Evaluation of oral and pharyngeal swallowing function Extended during PHE
92625 Assessment of tinnitus (includes pitch, loudness matching, and masking) Extended during PHE
93228 Heart rhythm tracing, computer analysis, and interpretation of patient-triggered events greater
than 24-hour EKG up to 30 days
Extended during PHE
93229 Heart rhythm tracing, computer analysis, physician prescribed transmission of patient-
triggered events greater than 24-hour EKG up to 30 days
Extended during PHE
93268
Heart rhythm symptom-related tracing and interpretation of 24-hour EKG monitoring up to 30
days Extended during PHE
93270 Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days Extended during PHE
93271 Heart rhythm symptom-related transmission and analysis of 24-hour EKG monitoring up to 30
days
Extended during PHE
93272 Heart rhythm symptom-related interpretation of 24-hour EKG monitoring up to 30 days Extended during PHE
93750 Evaluation of lower heart chamber assist device with physician analysis Extended during PHE
93797 Physician services for outpatient heart cardiac rehabilitation per session Extended during PHE
93798
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per
session Extended during PHE
94002 Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, initial day
Extended during PHE
94003 Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
Extended during PHE
94004 Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; nursing facility, per day
Extended during PHE
94005
Home ventilator management care plan oversight of a patient (patient not present) in home,
domiciliary or rest home (eg, assisted living) requiring review of status, review of laboratories
and other studies and revision of orders and respiratory care plan (as appropriate), within a
calendar month, 30 minutes or more
Extended during PHE
94664
Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer,
metered dose inhaler or IPPB device 96105 Assessment of aphasia (includes assessment of
expressive and receptive speech and language function, language comprehension , speech
production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination)
with interpretation and report, per hour Private Payor Plan
Extended during PHE
95970 Electronic analysis of implanted brain, spinal cord or peripheral stimulation device Extended during PHE
95971 Electronic analysis of implanted brain, spinal cord or peripheral stimulation device with simple spinal cord or peripheral nerve stimulator programming Extended during PHE
95972 Electronic analysis of implanted brain, spinal cord or peripheral stimulation device with
complex spinal cord or peripheral nerve stimulator programming
Extended during PHE
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 4
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
95983 Electronic analysis of implanted neurostimulator pulse generator/transmitter, first 15 minutes face-to-face time with physician or other qualified health care professional Extended during PHE
95984
Electronic analysis of implanted neurostimulator pulse generator/transmitter, each additional
15 minutes face-to-face time with physician or other qualified health care professional Extended during PHE
96040 Medical genetics and genetic counseling services, each 30 minutes face-to-face with
patient/family CPT
Extended during PHE
96105 Assessment of expressive and receptive speech with interpretation and report per hour Extended during PHE
96110 Developmental screening (eg, developmental milestone survey, speech and language delay
screen), with scoring and documentation, per standardized instrument
Extended during PHE
96112
Developmental test administration by qualified health care professional with interpretation
and report, first 60 minutes Extended during PHE
96113
Developmental test administration by qualified health care professional with interpretation
and report, additional 30 minutes Extended during PHE
96116 Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes In Existing Policy
96121 Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes Extended during PHE
96127
Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/
hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized
instrument
Extended during PHE
96130 Psychological testing evaluation by qualified health care professional, first 60 minutes Extended during PHE
96131 Psychological testing evaluation by qualified health care professional, additional 60 minutes Extended during PHE
96132 Neuropsychological testing evaluation services by physician or other qualified health care
professional, first 60 minutes
Extended during PHE
96133 Neuropsychological testing evaluation services by physician or other qualified health care
professional, additional 60 minutes
Extended during PHE
96136 Psychological or neuropsychological testing; first 30 minutes Extended during PHE
96137 Psychological or neuropsychological testing; additional 30 minutes Extended during PHE
96138 Psychological or neuropsychological test administration; first 30 minutes Extended during PHE
96139 Psychological or neuropsychological test administration; additional 30 minutes Extended during PHE
96156 Health behavior assessment, or re-assessment Extended during PHE
96158 Health behavior intervention, individual, face-to-face; initial 30 minutes Extended during PHE
96159 Health behavior intervention, individual, face-to-face; each additional 15 minutes (add-on
code)
Extended during PHE
96160 Administration of patient-focused health risk assessment instrument (e.g., health hazard
appraisal) with scoring and documentation, per standardized instrument
In Existing Policy
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 5
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
96161
Administration of caregiver-focused health risk assessment instrument (eg, depression
inventory) for the benefit of the patient, with scoring and documentation, per standardized
instrument
In Existing Policy
96164 Health behavior intervention, group (2 or more patients), face -to-face; initial 30 minutes Extended during PHE
96165 Health behavior intervention, group (2 or more patients), face -to-face; each additional 15
minutes (List separately in addition to code for primary service)
Extended during PHE
96167 Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes Extended during PHE
96168 Health behavior intervention, family (with the patient present), face -to-face; each additional
15 minutes (List separately in addition to code for primary service)
Extended during PHE
96170 Health behavior intervention, family (without the patient present), face -to-face; initial 30
minutes
Extended during PHE
96171 Health behavior intervention, family (without the patient present), face -to-face; each
additional 15 minutes (List separately in addition to code for primary service)
Extended during PHE
97110
Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility Extended during PHE
97112 Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes Extended during PHE
97116 Walking training to 1 or more areas, each 15 minutes Extended during PHE
97129
Therapeutic interventions that focus on cognitive function and compensatory strategies to
manage the performance of an activity, direct (one-on-one) patient contact; initial 15 minutes Extended during PHE
97130
Therapeutic interventions that focus on cognitive function and compensatory strategies to
manage the performance of an activity, direct (one-on-one) patient contact; each additional 15
minutes (add-on code)
Extended during PHE
97150 Therapeutic procedure(s), group (2 or more individuals) Extended during PHE
97151
Behavior identification assessment, administered by a physician or other qualified health care
professional, each 15 minutes of the physician's or other qualified health care professional's
time face-to-face with patient and/or guardian(s)/caregiver(s)
Extended during PHE
97152
Behavior identification-supporting assessment, administered by one technician under the
direction of a physician or other qualified health care professional, face-to-face with the
patient, each 15 minutes
Extended during PHE
97153
Adaptive behavior treatment by protocol, administered by technician under the direction of a
physician or other qualified health care professional, face -to-face with one patient, each 15
minutes
Extended during PHE
97154
Group adaptive behavior treatment by protocol, administered by technician under the
direction of a physician or other qualified health care professional, face-to-face with two or
more patients, each 15 minutes
Extended during PHE
97155
Adaptive behavior treatment with protocol modification, administered by physician or other
qualified health care professional, which may include simultaneous direction of technician,
face-to-face with one patient, each 15 minutes
Extended during PHE
97156
Family adaptive behavior treatment guidance, administered by physician or other qualified
health care professional (with or without the patient present), face -to-face with
guardian(s)/caregiver(s), each 15 minutes
Extended during PHE
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 6
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
97157
Multiple-family group adaptive behavior treatment guidance, administered by physician or
other qualified health care professional (without the patient present), face -to-face with
multiple sets of guardians/caregivers, each 15 minutes
Extended during PHE
97158
Group adaptive behavior treatment with protocol modification, administered by physician or
other qualified health care professional, face-to-face with multiple patients, each 15 minutes Extended during PHE
97161 Evaluation of physical therapy, typically 20 minutes Extended during PHE
97162 Evaluation of physical therapy, typically 30 minutes Extended during PHE
97163 Evaluation of physical therapy, typically 45 minutes Extended during PHE
97164 Re-evaluation of physical therapy, typically 20 minutes Extended during PHE
97165 Evaluation of occupational therapy, typically 30 minutes Extended during PHE
97166 Evaluation of occupational therapy, typically 45 minutes Extended during PHE
97167 Evaluation of occupational therapy established plan of care, typically 60 minutes Extended during PHE
97168 Re-evaluation of occupational therapy established plan of care, typically 30 minutes Extended during PHE
97530
Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve
functional performance), each 15 minutes Extended during PHE
97535
Self-care/home management training and compensatory training, meal preparation, safety
procedures, and instructions in use of assistive technology devices/adaptive equipment) direct
one-on-one contact, each 15 minutes
Extended during PHE
97542 Wheelchair management (e.g., assessment, fitting, training), each 15 minutes Extended during PHE
97750 Physical performance test or measurement with report, each 15 minutes Extended during PHE
97755 Assistive technology assessment to enhance functional performance, each 15 minutes Extended during PHE
97760
Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15
minutes Extended during PHE
97761 Training in use of prosthesis for arms and/or legs, per 15 minutes Extended during PHE
97802 Medical nutrition therapy; initial assessment and intervention, individual, face -to-face with the patient, each 15 minutes In Existing Policy
97803 Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes In Existing Policy
97804 Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes In Existing Policy
98960
Education and training for patient self-management by a qualified, nonphysician health care
professional using a standardized curriculum, face-to-face with the patient (could include
caregiver/family) each 30 minutes; individual patient
Extended during PHE
98961
Education and training for patient self-management by a qualified, nonphysician health care
professional using a standardized curriculum, face-to-face with the patient (could include
caregiver/family) each 30 minutes; 2-4 patients
Extended during PHE
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 7
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
98962
Education and training for patient self-management by a qualified, nonphysician health care
professional using a standardized curriculum, face-to-face with the patient (could include
caregiver/family) each 30 minutes; 5-8 patients
Extended during PHE
98966 Telephone assessment and management service, 5-10 minutes of medical discussion Extended during PHE
98967 Telephone assessment and management service, 11-20 minutes of medical discussion Extended during PHE
98968 Telephone assessment and management service, 21-30 minutes of medical discussion Extended during PHE
98970
Qualified nonphysician health care professional online digital evaluation and management
service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5 -10
minutes
Extended during PHE
98971
Qualified nonphysician health care professional online digital evaluation and management
service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11 -20
minutes
Extended during PHE
98972
Qualified nonphysician health care professional online digital evaluation and management
service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or
more minutes
Extended during PHE
99201 New patient office or other outpatient visit, typically 10 minutes In Existing Policy
99202 New patient office or other outpatient visit, typically 20 minutes In Existing Policy
99203 New patient office or other outpatient visit, typically 30 minutes In Existing Policy
99204 New patient office or other outpatient visit, typically 45 minutes In Existing Policy
99205 New patient office or other outpatient visit, typically 60 minutes In Existing Policy
99211 Established patient office or other outpatient visit, typically 5 minutes In Existing Policy
99212 Established patient office or other outpatient visit, typically 10 minutes In Existing Policy
99213 Established patient office or other outpatient visit, typically 15 minutes In Existing Policy
99214 Established patient office or other outpatient, visit typically 25 minutes In Existing Policy
99215 Established patient office or other outpatient, visit typically 40 minutes In Existing Policy
99217 Hospital observation care on day of discharge Extended during PHE
99218 Hospital observation care, typically 30 minutes Extended during PHE
99219 Hospital observation care, typically 50 minutes Extended during PHE
99220 Hospital observation care, typically 70 minutes Extended during PHE
99221 Initial hospital inpatient care, typically 30 minutes per day Extended during PHE
99222 Initial hospital inpatient care, typically 50 minutes per day Extended during PHE
99223 Initial hospital inpatient care, typically 70 minutes per day Extended during PHE
99224 Subsequent observation care, typically 15 minutes per day Extended during PHE
99225 Subsequent observation care, typically 25 minutes per day Extended during PHE
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 8
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
99226 Subsequent observation care, typically 35 minutes per day Extended during PHE
99231 Subsequent hospital inpatient care, typically 15 minutes per day In Existing Policy
99232 Subsequent hospital inpatient care, typically 25 minutes per day In Existing Policy
99233 Subsequent hospital inpatient care, typically 35 minutes per day In Existing Policy
99234 Hospital observation or inpatient care low severity, 40 minutes per day Extended during PHE
99235 Hospital observation or inpatient care moderate severity, 50 minutes per day' Extended during PHE
99236 Hospital observation or inpatient care high severity, 55 minutes per day Extended during PHE
99238 Hospital discharge day management, 30 minutes or less Extended during PHE
99239 Hospital discharge day management, more than 30 minutes Extended during PHE
99241 Patient office consultation, typically 15 minutes In Existing Policy
99242 Patient office consultation, typically 30 minutes In Existing Policy
99243 Patient office consultation, typically 40 minutes In Existing Policy
99244 Patient office consultation, typically 60 minutes In Existing Policy
99245 Patient office consultation, typically 80 minutes In Existing Policy
99251 Inpatient hospital consultation, typically 20 minutes In Existing Policy
99252 Inpatient hospital consultation, typically 40 minutes In Existing Policy
99253 Inpatient hospital consultation, typically 55 minutes In Existing Policy
99254 Inpatient hospital consultation, typically 80 minutes In Existing Policy
99255 Inpatient hospital consultation, typically 110 minutes In Existing Policy
99281 Emergency department visit, self limited or minor problem Extended during PHE
99282 Emergency department visit, low to moderately severe problem Extended during PHE
99283 Emergency department visit, moderately severe problem Extended during PHE
99284 Emergency department visit, problem of high severity Extended during PHE
99285 Emergency department visit, problem with significant threat to life or function Extended during PHE
99291 Critical care delivery critically ill or injured patient, first 30-74 minutes Extended during PHE
99292 Critical care delivery critically ill or injured patient Extended during PHE
99304 Initial nursing facility visit, typically 25 minutes per day Extended during PHE
99305 Initial nursing facility visit, typically 35 minutes per day Extended during PHE
99306 Initial nursing facility visit, typically 45 minutes per day Extended during PHE
99307 Subsequent nursing facility visit, typically 10 minutes per day In Existing Policy
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 9
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
99308 Subsequent nursing facility visit, typically 15 minutes per day In Existing Policy
99309 Subsequent nursing facility visit, typically 25 minutes per day In Existing Policy
99310 Subsequent nursing facility visit, typically 35 minutes per day In Existing Policy
99315 Nursing facility discharge day management, 30 minutes or less Extended during PHE
99316 Nursing facility discharge management, more than 30 minutes Extended during PHE
99324 New patient assisted living visit, typically 20 minutes Extended during PHE
99325 New patient assisted living visit, typically 30 minutes Extended during PHE
99326 New patient assisted living visit, typically 45 minutes Extended during PHE
99327 New patient assisted living visit, typically 60 minutes Extended during PHE
99328 New patient assisted living visit, typically 75 minutes Extended during PHE
99334 Established patient assisted living visit, typically 15 minutes Extended during PHE
99335 Established patient assisted living visit, typically 25 minutes Extended during PHE
99336 Established patient assisted living visit, typically 40 minutes Extended during PHE
99337 Established patient assisted living visit, typically 60 minutes Extended during PHE
99341 New patient home visit, typically 20 minutes Extended during PHE
99342 New patient home visit, typically 30 minutes Extended during PHE
99343 New patient home visit, typically 45 minutes Extended during PHE
99344 New patient home visit, typically 60 minutes Extended during PHE
99345 New patient home visit, typically 75 minutes Extended during PHE
99347 Established patient home visit, typically 15 minutes Extended during PHE
99348 Established patient home visit, typically 25 minutes Extended during PHE
99349 Established patient home visit, typically 40 minutes Extended during PHE
99350 Established patient home visit, typically 60 minutes Extended during PHE
99354 Prolonged office or other outpatient service first hour In Existing Policy
99355 Prolonged office or other outpatient service each 30 minutes beyond first hour In Existing Policy
99356 Prolonged inpatient or observation hospital service first hour In Existing Policy
99357 Prolonged inpatient or observation hospital service each 30 minutes beyond first hour In Existing Policy
99381 Initial new patient preventive medicine evaluation infant younger than 1 year Extended during PHE
99382 Initial new patient preventive medicine evaluation, age 1 through 4 years Extended during PHE
99383 Initial new patient preventive medicine evaluation, age 5 through 11 years Extended during PHE
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 10
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
99384 Initial new patient preventive medicine evaluation, age 12 through 17 years Extended during PHE
99385 Initial new patient preventive medicine evaluation age 18-39 years Extended during PHE
99386 Initial new patient preventive medicine evaluation age 40-64 years Extended during PHE
99387 Initial new patient preventive medicine evaluation, age 65 years and older Extended during PHE
99391 Established patient periodic preventive medicine examination infant younger than 1 year Extended during PHE
99392 Established patient periodic preventive medicine examination, age 1 through 4 years Extended during PHE
99393 Established patient periodic preventive medicine examination, age 5 through 11 years Extended during PHE
99394 Established patient periodic preventive medicine examination, age 12 through 17 ye ars Extended during PHE
99395 Established patient periodic preventive medicine examination age 18 -39 years Extended during PHE
99396 Established patient periodic preventive medicine examination age 40 -64 years Extended during PHE
99397 Established patient periodic preventive medicine examination, age 65 years and older Extended during PHE
99401 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes Private Payor Plan Extended during PHE
99402 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes Private Payor Plan Extended during PHE
99403 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes Private Payor Plan Extended during PHE
99404 Preventive medicine counseling and/or risk factor reduction intervention(s) provi ded to an individual (separate procedure); approximately 60 minutes Extended during PHE
99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes In Existing Policy
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes In Existing Policy
99408 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST),
and brief intervention (SBI) services; 15 to 30 minutes
In Existing Policy
99409 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST),
and brief intervention (SBI) services; greater than 30 minutes
In Existing Policy
99421 Online digital evaluation and management service, for an established patient, for up to 7 days,
cumulative time during the 7 days; 5-10 minutes
Extended during PHE
99422 Online digital evaluation and management service, for an established patient, for up to 7 days,
cumulative time during the 7 days; 11-20 minutes
Extended during PHE
99423 Online digital evaluation and management service, for an established patient, for up to 7 days,
cumulative time during the 7 days; 21 or more minutes
Extended during PHE
99441 Physician telephone patient service, 5-10 minutes of medical discussion Extended during PHE
99442 Physician telephone patient service, 11-20 minutes of medical discussion Extended during PHE
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 11
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
99443 Physician telephone patient service, 21-30 minutes of medical discussion Extended during PHE
99468 Initial inpatient hospital critical care of newborn, 28 days of age or younger, per day Extended during PHE
99469 Subsequent inpatient hospital critical care of newborn, 28 days of age or younger, per day Extended during PHE
99471
Initial inpatient hospital critical care of infant or young child, 29 days through 24 months of
age, per day Extended during PHE
99472 Subsequent inpatient hospital critical care of infant or young child, 29 days through 24 months
of age, per day
Extended during PHE
99473 Self-measured blood pressure using a device validated for clinical accuracy; patient
education/training and device calibration
Extended during PHE
99475 Initial inpatient hospital critical care of infant or young child, 2 through 5 years of age, per day Extended during PHE
99476
Subsequent inpatient hospital critical care of infant or young child, 2 through 5 years of age,
per day Extended during PHE
99477 Initial intensive care of newborn, 28 days of age or younger, per day Extended during PHE
99478 Subsequent intensive care of recovering low birth weight infant, per day Extended during PHE
99479 Subsequent intensive care of recovering low birth weight infant, per day Extended during PHE
99480 Subsequent intensive care of recovering low birth weight infant, per day Extended during PHE
99483
Assessment of and care planning for patient with impaired thought processing, typically 50
minutes Extended during PHE
99495 Transitional care management services, moderately complexity, requiring face -to-face visits
within 14 days of discharge
In Existing Policy
99496
Transitional care management services, highly complexity, requiring face -to-face visits within 7
days of discharge In Existing Policy
99497 Advance care planning by the physician or other qualified health care professional In Existing Policy
99498 Advance care planning by the physician or other qualified health care professional (add -on
code)
In Existing Policy
0373T Adaptive behavior treatment with protocol modification for patient exhibiting destructive behavior, each 15 minutes of technicians' face-to-face time Extended during PHE
S9152 Speech therapy, re-eval Extended during PHE
0362T Behavior identification supporting assessment for patient exhibiting destructive behavior, each
15 minutes of technicians' face-to-face time
Extended during PHE
0373T
Adaptive behavior treatment with protocol modification for patient exhibiting destructive
behavior, each 15 minutes of technicians' face-to-face time Extended during PHE
90887 HF Explanation of psychiatric, medical examinations, procedures, and data to other than patient; substance abuse program Extended during PHE
90887 UC
Explanation of psychiatric, medical examinations, procedures, and data to other than patient;
Medicaid level of care 12 Extended during PHE
G0108 Diabetes outpatient self-management training services, individual, per 30 minutes In Existing Policy
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 12
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes In Existing Policy
G0270
Medical nutrition therapy; reassessment and subsequent intervention(s) following second
referral in same year for change in diagnosis, medical condition or treatment regimen, each 15
minutes
In Existing Policy
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) In Existing Policy
G0396
Alcohol and/or substance (other than tobacco) abuse structured assessment (eg, AUDIT,
DAST). and brief intervention 15 to 30 minutes In Existing Policy
G0397 Alcohol and/or substance (other than tobacco) abuse structured assessment (eg, AUDIT,
DAST). and intervention, greater than 30 minutes
In Existing Policy
G0406 Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth In Existing Policy
G0407
Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes
communicating with the patient via telehealth In Existing Policy
G0408 Follow-up inpatient consultation, complex, physicians typically spend 35 minutes
communicating with the patient via telehealth
In Existing Policy
G0410
Group psychotherapy other than of a multiple-family group, in a partial hospita lization setting,
approximately 45 to 50 minutes Extended during PHE
G0420 Face-to-face educational services related to the care of chronic kidney disease; individual, per
session, per one hour
In Existing Policy
G0421 Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour In Existing Policy
G0422
Intensive cardiac-rehabilitation; with or without continuous ECG monitoring with exercise, per
session Extended during PHE
G0423 Intensive cardiac rehabilitation; with or without continuous ECG monitoring; without exercise,
per session
Extended during PHE
G0424 Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day Extended during PHE
G0425
Telehealth consultation, emergency department or initial inpatient, typically 30 minutes
communicating with the patient via telehealth In Existing Policy
G0426 Telehealth consultation, emergency department or initial inpatient, typically 50 minutes
communicating with the patient via telehealth
In Existing Policy
G0427
Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or
more communicating with the patient via telehealth In Existing Policy
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit Extended during PHE
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit Extended during PHE
G0442 Annual alcohol misuse screening, 15 minutes Extended during PHE
G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes Extended during PHE
G0444 Annual depression screening, 15 minutes Extended during PHE
G0445 High intensity behavioral counseling, 30 minutes In Existing Policy
G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15
minutes
In Existing Policy
G0447 Face-to-face behavioral counseling for obesity, 15 minutes Extended during PHE
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 13
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
G0459 Inpatient telehealth pharmacologic management, including prescription, use, and review of
medication with no more than minimal medical psychotherapy
Extended during PHE
G0506 Comprehensive assessment of and care planning for patients requiring chronic care
management services (add-on code)
In Existing Policy
G0508 Telehealth consultation, critical care, initial , physicians typically spend 60 minutes
communicating with the patient and providers via telehealth
In Existing Policy
G0509 Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes
communicating with the patient and providers via telehealth
In Existing Policy
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 (add-on code)
In Existing Policy
G0514
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;
each additional 30 minutes (add-on code)
In Existing Policy
G2010 Remote evaluation of recorded video and/or images submitted by an established patient Extended during PHE
G2012 Brief communication technology-based service, e.g., virtual check-in, 5-10 minutes of medical
discussion
Extended during PHE
G2025
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally
qualified health center (fqhc) only Extended during PHE
G2061 Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5 -10 minutes Extended during PHE
G2062
Qualified nonphysician health care professional online assessment and management service,
for an established patient, for up to 7 days, cumulative time during the 7 days; 11 -20 minutes Extended during PHE
G2063
Qualified nonphysician qualified health care professional assessment and management service,
for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more
minutes
Extended during PHE
G2067 Medication assisted treatment, methadone; weekly bundle including dispensing and
counseling
Extended during PHE
G2068 Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and
counseling
Extended during PHE
G2073 Medication assisted treatment, naltrexone; weekly bundle including dispensing and counseling Extended during PHE
G2074 Medication assisted treatment, weekly bundle not including the drug, including counseling Extended during PHE
G2076 Intake activities, includes preparation of a treatment plan (add-on code) Extended during PHE
G2077 Periodic assessment; for services and treatment (add-on code) Extended during PHE
G2080 Each additional 30 minutes of counseling in a week (add-on code) Extended during PHE
G2086
Office-based treatment for opioid use disorder, including development of the treatment plan,
care coordination, individual therapy and group therapy and counseling; at least 70 minutes in
the first calendar month
Extended during PHE
G2087
Office-based treatment for opioid use disorder, including care coordination, individual therapy
and group therapy and counseling; at least 60 minutes in a subsequent calendar month Extended during PHE
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020
Page | 14
Code Service Description
Telemedicine
Reimbursement
Policy Position
Medicaid
G2088
Office-based treatment for opioid use disorder, including care coordination, individual therapy
and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes
(add-on code)
Extended during PHE
G9685
Physician service or other qualified health care professional for the evaluation and
management of a beneficiary's acute change in condition in a nursing facility. this service is for
a demonstration project
Extended during PHE
H0001 Alcohol and drug assessment Extended during PHE
H0002 Behavioral health screening to determine eligibility for admission to treatment program Extended during PHE
H0004 Behavioral health counseling and therapy, per 15 minutes Extended during PHE
H0006 HF Navigator services (Maintenance) Extended during PHE
H0006 HF
HG
Navigator psychosocial assessment & patient-specific Treatment plan development (Initiation) Extended during PHE
H0006 HF
SU
Navigator services (Stabilization) Extended during PHE
H0014 Alcohol and/or drug services; ambulatory detoxification Extended during PHE
H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) Extended during PHE
H0020 HF Methadone (per diem) Extended during PHE
H0020 HF
26
Methadone (bundled) Extended during PHE
H0032 Mental Health service plan development by a non-physician, per 15 minutes Extended during PHE
H0033 HF non-Methadone (per diem) Extended during PHE
H0033 HF
26
non-Methadone (bundled) Extended during PHE
H0035 Mental health partial hospitalization, treatment, less than 24 hours Extended during PHE
H0047 Alcohol and/or other drug abuse services, not otherwise specified Extended during PHE
H2036 HF Alcohol and/or other drug treatment program, per diem; substance abuse program Extended during PHE
S9152 Speech therapy, re-evaluation Extended during PHE
Please note: Additional benefits may be available as codes are subject to change frequently based on evolving guidance from CMS.
CPT? is a registered mark of the American Medical Association.
Horizon NJ Health Existing and Extended
Telemedicine Policy Codes
Updated on November 13, 2020