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Telemedicine Coding for Wound Care

Telemedicine Coding for Wound Care

Telemedicine Coding for Wound Care

Instructions: Click on the header of each column to sort (e.g., click on "CPT/ HCPCS codes" to sort by product names in alphabetical order), or use the "search" field to find a specific product

Sources: AMA CPT® 2020 Professional Edition [1], Centers for Medicare and Medicaid (CMS)[2]. This table is constantly being updated, and new products may be added or deleted without notice. Abbreviations: QHP: qualified healthcare professional - on this document the term includes: Physician, Nurse practitioner (NP), Certified nurse specialist (CNS), Physician assistant (PA), Certified nurse mid-wife (CNM), Certified registered nurse anesthetist (CRNA), Clinical social worker (CSW), Physical therapist (PT) NEW: Starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for CMS Telehealth professional services furnished to beneficiaries in all areas of the country in all settings (see Fact Sheet)


  • CPT/ HCPCS Codes Description Encounter typeComments/ Notes
    99354
    • Prolonged E&M/psyctx serv outpat, 30-74min
    • Prolonged evaluation and management or psychotherapy 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 hour (List separately in addition to code for office or other outpatient Evaluation and Management or psychotherapy service)
    Provider to provider 
    • Requestor code. Use in addition to 99452 for the time spent on the interprofessional tel/Internet/EMR discussion with consultant if the time exceeds 30 min covered by 99452.  Pat. is present in the office or other outpatient setting.
    • Use code only once per date, to report the total duration of face-to-face time, even if the time spent on that date is not continuous
    • E.g.: if total duration of service is 30-74 min, report 99452x1 and 99354x1; if 75-104 min, report 99452x1, 99354x1, 99355x1
    99355
    • Prolonged E&M/psyctx serv outpat add'l 30min
    • Prolonged evaluation and management or psychotherapy 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 (List separately in addition to code for prolonged service)
    Provider to Provider
    • Requestor code. Prolonged serv. code, patient present with requesting QHP in office/outpatient setting
    • List separately in addition to code for prolonged service 99354
    • E.g.: if total duration of service is 30-74 min, report 99452x1 and 99354x1; if 75-104 min, report 99452x1, 99354x1, 99355x1
    99356
    • Prolonged service inpat/observ, 30-74min
    • Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient Evaluation and Management service)
    Provider to Provider
    • Requestor code. Use in addition to 99452 for the time spent on the interprofessional tel/Internet/EMR discussion with consultant if the time exceeds 30 min covered by 99452. Requestor is at the bedside and on the patient’s floor/unit in the hospital/nursing facility
    • Use code only once per date, to report the total duration of face-to-face time, even if the time spent on that date is not continuous
    • E.g.: if total duration of service is 30-74 min, report 99452x1 and 99356x1
    99357
    • Prolonged service inpat/observ, add'l 30 min
    • Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; each additional 30 minutes (List separately in addition to code for prolonged service)
    Provider to Provider
    • Requestor code. Prolonged serv. code, patient present with requesting QHP at the bedside and on the patient’s floor/unit in the hospital/nursing facility
    • List separately in addition to code for prolonged service 99356
    • E.g.: if total duration of service is 30-74 min, report 99452x1 and 99356x1; if 75-104 min, report 99452x1, 99356x1, 99357x1
    99358
    • Prolonged serv. w/o pat contact, 30-74min
    •  Prolonged evaluation and management service before and/or after direct patient care; first hour
    Provider to Provider
    • Requestor code. Use in addition to 99452 if the interprofessional telephone/Internet/electronic health record E/M service occurs when the patient is not present and the time spent in a day exceeds the 30 minutes covered by 99452 
    • 99358 may be reported on a different date than 99452
    • E.g.: if total duration of service is 30-74 min, report 99452x1, 99358x1; if 75-104 min, report 99452x1, 99358x1, 99359x1
    99359
    • Prolonged serv. w/o pat contact add'l 30
    • Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes (List separately in addition to code for prolonged service)
    Provider to Provider
    • *Requestor code, prolonged serv. code, patient not present w/ requesting QHP
    • *List separately in addition to code for prolonged service 99358
    • E.g.: if total duration of service is 30-74 min, report 99452x1, 99358x1; if 75-104 min, report 99452x1, 99358x1, 99359x1
    99446
    • Interprof Tel/Internt/EMR Cons. 5-10 min V+W
    • Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review
    Provider to Provider
    • Consultant code, QHP to QHP, verbal and written report
    • Frequency: do not report if pt seen in the past 14 days or if ITC results in transfer or in-person consult in the next 14 days 
    • Do not report more than once in 7 days
    • Time based service: report if >50% service is verbal discussion
    99447
    • Interprof Tel/Internt/EMR Cons.11-20 min V+W
    • Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional; 11-20 minutes of medical consultative discussion and review
    Provider to Provider
    • Consultant code, QHP to QHP, verbal and written report
    • Frequency: do not report if pt seen in the past 14 days or if ITC results in transfer or in-person consult in the next 14 days 
    • Do not report more than once in 7 days
    • Time based service: report if >50% service is verbal discussion
    99448
    • Interprof Tel/Internt/EMR Cons. 21-30min V+W
    • Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional; 21-30 minutes of medical consultative discussion and review
    Provider to Provider
    • Consultant code, QHP to QHP, verbal and written report
    • Frequency: do not report if pt seen in the past 14 days or if ITC results in transfer or in-person consult in the next 14 days 
    • Do not report more than once in 7 days
    • Time based service: report if >50% service is verbal discussion
    99449
    • Interprof Tel/Internet/EMR Cons. >=31 V+W
    • Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional; 31 minutes or more of medical consultative discussion and review
    Provider to Provider
    • Consultant code, QHP to QHP, verbal and written report
    • Frequency: do not report if pt seen in the past 14 days or if ITC results in transfer or in-person consult in the next 14 days 
    • Do not report more than once in 7 days
    • Time based service: report if >50% service is verbal discussion
    99451
    • Interprof Tel/Internet/EMR Cons. >=5  W
    •  Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient's treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time
    Provider to Provider
    • Consultant code, QHP to QHP, written report
    • If >50% time spent on written assessment, management and documentation (as opposed to verbal discussion), report this code
    99452
    • Interprof Tel/Internt/EMR REFERRAL svc, 30min
    • Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes
    Provider to Provider
    • Requestor code (physician or other QHP), first 16-30 minutes
    • Report 99452 if spending 16-30 minutes/day preparing for the referral and/or communicating w/ consultant. Do not report more than 1x in 14-day period
    G2010
    • Remote evaluation 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 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
    Patient to provider
    • Store-and-forward.
    • Initiated by established pt., furnished by physician/QHP. 
    • Remote evaluation of recorded video and/or images submitted (e.g., store and forward)
    • Includes interpretation with follow-up within 24 business hours, 
    • Not originating from a related e/m service provided within the previous 7 days
    • Not leading to an E/M service or procedure within the next 24 hours or soonest available appointment
    • Consent required (verbal, written or electronic)
    • Requires that the patient or non-QHP clinician facilitating the service create a WoundReference Free Basic account and be able to send/receive emails
    • Requestor needs a desktop/ tablet/ mobile with audio and camera and internet
    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, not originating from a related 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; 5-10 minutes of medical discussion
    Patient to provider
    • Virtual check-in. Does not require that the patient or non-QHP clinician facilitating the service (requestor) create a WoundReference Free Basic account.
    • Initiated by established pt., furnished by physician/QHP.
    • Used when QHP not sure if patient needs an in person appt.
    • 5-10 minutes of medical discussion
    • Not originating from a related e/m service provided within the previous 7 days 
    • Not leading to an e/m service or procedure within the next 24 hours or soonest available appointment
    • Consent required (verbal)
    • Can be furnished via WoundReference free, HIPAA compliant TeleVisit Tool Video Chat Edition (allows providers to see the wound, dressing etc). Telephone may also be used 
    99421
    • Online digital E/M, e-visit, 5-10 min
    • Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
    Patient to provider
    • Initiated by established pt., furnished by QHP. Encounter must be documented on a HIPAA compliant platform
    • Requires E/M of the pt. 
    • Time based service, 5-10 min. Reported once for the QHP’s cumulative time devoted to the service during a 7 day period.
    99422
    • Online digital E/M, e-visit, 11-20 min
    • Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
    Patient to provider
    • Initiated by established pt., furnished by QHP. Encounter must be documented on a HIPAA compliant platform
    • Requires E/M of the pt. 
    • Time based service, 11-20 min. Reported once for the QHP’s cumulative time devoted to the service during a 7 day period.
    99423
    • Online digital E/M, e-visit, > 21 min
    • 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
    Patient to provider
    • Initiated by established pt., furnished by QHP. Encounter must be documented on a HIPAA compliant platform
    • Requires E/M of the pt. 
    • Time based service, > 21 min. Reported once for the QHP’s cumulative time devoted to the service during a 7 day period.
    G2061
    • Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes
    Patient to provider
    • Similar 99421, but can be billed by practitioners who cannot independently bill E/M services
    G2062
    • Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes
    Patient to provider
    • Similar 99422, but can be billed by practitioners who cannot independently bill E/M services
    G2063
    • Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; >21 minutes
    Patient to provider
    • Similar 99423, but can be billed by practitioners who cannot independently bill E/M services
    99201
    • CMS Telehealth E/M office or outpt. visit, new pt., 10 min 
    • Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family
    Patient to provider (CMS Telehealth)
    • Geographical and care setting restrictions may apply. See CMS MLN Booklet [2]
    • QHP must use interactive audio and video telecommunications system that permits real-time communication between provider and patient 
    • Store and forward allowed in AK and HI
    99202
    • CMS Telehealth E/M office or outpt. visit, new pt., 20 min 
    • Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family
    Patient to provider (CMS Telehealth)
    • Geographical and care setting restrictions may apply. See CMS MLN Booklet [2]
    • QHP must use interactive audio and video telecommunications system that permits real-time communication between provider and patient 
    • Store and forward allowed in AK and HI
    99203
    • CMS Telehealth E/M office or outpt. visit, new pt., 30 min 
    • Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family
    Patient to provider (CMS Telehealth)
    • Geographical and care setting restrictions may apply. See CMS MLN Booklet [2]
    • QHP must use interactive audio and video telecommunications system that permits real-time communication between provider and patient 
    • Store and forward allowed in AK and HI
    99204
    • CMS Telehealth E/M office or outpt. visit, new pt., 45 min 
    • Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family
    Patient to provider (CMS Telehealth)
    • Geographical and care setting restrictions may apply. See CMS MLN Booklet [2]
    • QHP must use interactive audio and video telecommunications system that permits real-time communication between provider and patient 
    • Store and forward allowed in AK and HI
    99205
    • CMS Telehealth E/M office or outpt. visit, new pt., 60 min 
    • Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family
    Patient to provider (CMS Telehealth)
    • Geographical and care setting restrictions may apply. See CMS MLN Booklet [2]
    • QHP must use interactive audio and video telecommunications system that permits real-time communication between provider and patient 
    • Store and forward allowed in AK and HI
    99211
    • CMS Telehealth E/M office or outpt. visit, established pt., 5 min 
    • Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services
    Patient to provider (CMS Telehealth)
    • Geographical and care setting restrictions may apply. See CMS MLN Booklet [2]
    • QHP must use interactive audio and video telecommunications system that permits real-time communication between provider and patient 
    • Store and forward allowed in AK and HI
    99212
    • CMS Telehealth E/M office or outpt. visit, established  pt., 10 min 
    • Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes
    Patient to provider (CMS Telehealth)
    • Geographical and care setting restrictions may apply. See CMS MLN Booklet [2]
    • QHP must use interactive audio and video telecommunications system that permits real-time communication between provider and patient 
    • Store and forward allowed in AK and HI
    99213
    • CMS Telehealth E/M office or outpt. visit, established  pt., 15 min 
    • Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family
    Patient to provider (CMS Telehealth)
    • Geographical and care setting restrictions may apply. See CMS MLN Booklet [2]
    • QHP must use interactive audio and video telecommunications system that permits real-time communication between provider and patient 
    • Store and forward allowed in AK and HI
    99214
    • CMS Telehealth E/M office or outpt. visit, established  pt., 25 min 
    • Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family
    Patient to provider (CMS Telehealth)
    • Geographical and care setting restrictions may apply. See CMS MLN Booklet [2]
    • QHP must use interactive audio and video telecommunications system that permits real-time communication between provider and patient 
    • Store and forward allowed in AK and HI
    99215
    • CMS Telehealth E/M office or outpt. visit, established  pt., 40 min 
    • Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
    Patient to provider (CMS Telehealth)
    • Geographical and care setting restrictions may apply. See CMS MLN Booklet [2]
    • QHP must use interactive audio and video telecommunications system that permits real-time communication between provider and patient 
    • Store and forward allowed in AK and HI
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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

REFERENCES

  1. American Medical Association. CPT® 2020 Professional Edition . 2020;.
  2. Centers for Medicare and Medicaid. Telehealth Services - MLN Booklet . 2019;.
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