2021 Annual Update to the Medicare Therapy Code List (Effective from January 1, 2021)

Some HCPCS/CPT codes are considered communication technology-based (CTB) services, so Nonphysician Practitioners  (NPPs), such as psychologists, social workers, and therapists, can furnish the services. The CY 2021 rulemaking made the codes permanent, meaning that they are no longer restricted by the effectiveness timeline of the Public Health Emergency (PHE) for COVID-19. To know more, keep reading!

Since the HCPCS/CPT codes below are considered communication technology-based (CTB) services, Nonphysician Practitioners  (NPPs), such as psychologists, social workers, and therapists (including physical therapists, occupational therapists, and speech-language pathologists), can furnish the services —in private practice or in facility-based. These codes for CTB services also replaced codes for similar services, and for the first five HCPCS/CPT codes below, CY 2021 rulemaking made the codes permanent, which means that they are no longer restricted by the effectiveness timeline of the Public Health Emergency (PHE) for COVID-19. Here are the HCPCS CPT Codes and their long descriptors:

• HCPCS code G2250: This code is used to report a remote assessment of recorded video and/or images submitted by an established patient (for example, store and forward), and the services here include interpretation and following-up with the patient within 24 business hours. This must not be originating from a related service provided within the previous 7 days or lead to a service or procedure within the next 24 hours or soonest available appointment. HCPCS code G2250 replaced HCPCS code G2010.
• HCPCS code G2251: This is for a brief communication technology-based service — for example, virtual check-in — by a qualified health care professional who cannot 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 a service or procedure within the next 24 hours or soonest available. HCPCS code G2251 replaced HCPCS code G2012.

The following three codes — CPT codes 98970, 98971, and 98972 — were created by the CPT Editorial Panel for CY 2020 for online digital evaluation and management services (see below). Since the codes’ descriptors of G2061, G2062, and G2063 are similar to the above, CMS decided to replace them. Here are the CPT codes and their long descriptors:

Ø  CPT 98970: This is for qualified non-physician health care professional online digital evaluation and management service, for an established patient, for up to 7 days: cumulative time during the 7 days being 5-10 minutes. CPT code 98970 replaced HCPCS code G2061.

Ø  CPT 98971: This is for qualified non-physician health care professional online digital evaluation and management service, for an established patient, for up to 7 days: cumulative time during the days being 11-20 minutes. CPT code 98971 replaced HCPCS code G2062.

Ø  CPT 98972: This is for qualified non-physician health care professional online digital evaluation and management service, for an established patient, for up to 7 days: cumulative time during the 7 days is 21 or more minutes. CPT code 98972 replaced HCPCS code G2063.

Effective for the duration of the PHE for COVID-19, these CPT codes for telephone assessment services are considered as “sometimes therapy” codes. Here are the CPT codes and their long descriptors:

§  CPT 98966: The code is used to report a telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 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: The code is for a telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion

§  CPT 98968: This is for a telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion.

Effective for dates of service on and after January 1, 2021, the following HCPCS codes are no longer in the therapy code list:

• G2010
• G2012
• G2061
• G2062
• G2063

The therapy code listing is available at http://www.cms.gov/Medicare/Billing/TherapyServices/index.html.

Source: https://www.cms.gov/files/document/mm12126.pdf