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Telehealth on iPad. Increasing numbers of procedures are covered by Medicare

Telehealth Visits Show Growth in Benefits for Insureds

Telehealth Update – CMS to Start Covering in Home Monitoring

Telehealth update: Health plans are beginning to offer telemedicine services to their insureds that offer 24/7 access to online doctor visits.  For example, BlueCare is a benefit for most insureds of BlueShield of Louisiana.  As a result, online visits are intended to serve members with non-emergency minor illnesses such as colds (ICD-10 code R09.81 – Nasal congestion).  Also, allergies, bladder infections (for example O86.22 – Infection of bladder following delivery), sinus trouble, mild stomach upsets or rashes.  Due to these developments, patients can have an encounter with a physician via mobile device such as an iPhone, iPad, or Android device, over their desktop computer or laptop.

According to the Center for Connected Health Policy, “Telehealth is a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies. Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services.”

Although BlueCare offers a limited set of services initially, Telemedicine services that are eligible for coverage under Medicare including the following HCPCS and CPT codes:

  • Telehealth consultations, emergency department or initial inpatient (G0425-G0427). Effective Jan. 1, 2010.
  • Follow-up inpatient telehealth consultations (G0425-G0427). Effective Jan. 1, 2009.
  • Office or other outpatient visits (99201-99215).
  • Subsequent hospital care services, with the limitation of one telehealth visit every three days (CPT codes 99231-99233). Effective Jan. 1, 2011.
  • Subsequent nursing facility care services, with the limitation of one telehealth visit every 30 days (99307-99310). Effective Jan. 1, 2011.
  • Pharmacologic management March 1, 2003 – Dec. 31, 2012 (90862). (G0459) Effective Jan. 1, 2013
  • Individual psychotherapy (90804-90809); Psychiatric diagnostic interview examination (90801). Effective March 1, 2003 – Dec. 1, 2013.
  • Individual psychotherapy (90832-90834, 90836-90838) ; Psychiatric diagnostic interview examination (90791-90792) Effective Jan. 1, 2013.
  • Neurobehavioral status exam (96116). Effective Jan. 1, 2008.
  • End Stage Renal Disease (ESRD) related services (90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961). Effective Jan. 1, 2009.
  • Individual and group medical nutrition therapy (G0270, 97802-97804). Individual effective Jan. 1, 2006. Group effective Jan. 1, 2011.
  • Individual and group health and behavior assessment and intervention (96150-96154). Individual effective Jan. 1, 2010; group effective Jan. 1, 2011.
  • Individual and group kidney disease education (KDE) services (HCPCS codes G0420-G0421). Effective Jan. 1, 2011.
  • Individual and group diabetes self-management training (DSMT) services, with a minimum of 1 hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training (G0108-G0109). Effective Jan. 1, 2011.
  • Smoking Cessation Services (99406-99407 and G0436-G0437). Effective Jan. 1, 2012.
  • Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services (G0396-G0397) Effective January 1, 2013.
  • Annual alcohol misuse screening (G0442) Effective January 1, 2013.
  • Brief face-to-face behavioral counseling for alcohol misuse (G0443) Effective January 1, 2013.
  • Annual Depression Screening (G0444) Effective January 1, 2013.
  • High-intensity behavioral counseling to prevent sexually transmitted infections (G0445) Effective January 1, 2013.
  • Annual, face-to-face Intensive behavioral therapy for cardiovascular disease (G0446) Effective January 1, 2013.
  • Face-to-face behavioral counseling for obesity (G0447) Effective January 1, 2013.
  • Transitional Care Management Services (99495-99496) Effective January 1, 2014.

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Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See and for more about the company.

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