When conducted over the phone, should providers bill their Evaluation and Management (E/M) Office Visits as previously instructed?

YES. See #1 & #2 in MORE HELPFUL INFORMATION below.

How should providers bill follow-ups, lab results, and (5-10 minutes) phone discussions?

Bill with G2012, NOT in conjunction with E/M Office Visits. See #3 in MORE HELPFUL INFORMATION below

Can Behavioral Health Providers bill for services delivered by Telehealth?

Yes. Use POS 02 & Modifier 95.

How should FQHCs/RHCs and Indian Health Service Providers submit claims?

They should submit using the T1015 and Modifier 95 to allow the encounter to qualify for the PPS.

NOTE – Look for additional communications specific for FQHC/RHC. Please call HPSJ Customer Service with any questions.

1. E/M Codes should be billed with POS 02 and modifier 95 (office visits)
   • Definition from DHCS: Medi-Cal providers may bill their managed care plan as appropriate for any covered Medi-Cal benefits or services using the appropriate procedure codes (CPT/HCPCS) that are appropriate to be provided via a telehealth modality.
   • The benefits or service delivered via telehealth must meet the procedural definitions and components of the CPT/HCPCS billed
2. E-Consults (CPT Code 99451) in conjunction with modifier GQ: Interprofessional telephone/internet/electronic health record assessment and management services provided by consultative physician, including written report of the patient’s treatment of 5 or more minutes.
3. Other Virtual/Telephonic Communications (not to billed in conjunction with E/M or other procedure codes)
   • HCPCS code G2010: Remote evaluation of recorded video and/or image submitted by an established patient, including interpretation with follow-up with the patient within 24 hours, not originating from a related evaluation ad management (E/M) service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
   • HCPCS code G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion. G2012 can be billed when the virtual communication occurred via a telephone call.

See:https://www.dhcs.ca.gov/Documents/COVID-19/Telehealth_Other_Virtual_Telephonic_Communications_V3.0.pdf