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Medicare Approves Reimbursement for Virtual Communication (G2012)

Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Medicare has taken a stand to recognize communication technology-based services by approving two newly defined physicians' services that will significantly help providers who deal with phone calls and patient triage. One of these services includes: 

  • Virtual check-in (G2012), which allows the provider to be reimbursed for communicating with the patient via telephone or another telecommunications device to determine whether or not the patient needs to come into the office for an evaluation or not. 

This is not a Telemedicine service, which would restrict it to specific patient locations but rather is a technology-based service like 99441-99443, which are reported to other payers for the same technology-based service. There are specific criteria that must be met in order to report this code, including: 

  • Medical necessity for the communication
  • Only available to established patients of the provider
  • The patient must be made aware of cost-sharing (deductible and coinsurance) and that the service will be billed to Medicare
  • Only reportable by physicians or other qualified healthcare providers who are eligible to report E/M services (e.g., clinical staff communication with the patient is not eligible)
  • The virtual encounter communication cannot be related to a prior E/M encounter (within 7 days prior to the communication) or within 24 hours following the communication (or soonest available appointment). If the provider says to make an appointment, it will be bundled into that E/M service and not reportable as G2012 but instead should be reported as part of the E/M service 99211-99215 or 99241-99245
  • Only real-time communications will meet the criteria (e.g., telephone, live video, etc.). Asynchronous communication (e.g., text, email, voicemail) will not be eligible for reporting G2012

Documentation Requirements

To avoid issues with code compliance or audits, it is important that the provider understands what documentation requirements accompany reporting this code, which include: 

  • Medical necessity for the service
  • The type of technology used to communicate with the patient (e.g., telephone, video chat, email, etc.). If an unapproved form of communication is used, the service will be ineligible for reimbursement so this needs to be identified within the record as well.
  • The date of the communication and a brief summary of what was discussed
  • An assessment and plan, like any other E/M service
  • Provider signature and date signed

Medicare's HCPCS code describes the service as follows:

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