Telehealth and Pain Management

When facing the Coronavirus, a pain physician needs to first consider protecting patients, staff, and self. Telehealth was introduced years ago, but the recent COVID-19 outbreak is hastening the transition for some providers.

While, I have already performed Telehealth visits with patients in other states, and those who cannot make it to my office, I wonder how the future of pain medicine will look after the recent COVID-19 outbreak. Many of our elderly patients are already frightened from coming to our waiting rooms, and the volume of elective procedures is dropping across most specialties as the public is encouraged to isolate themselves in an effort to curb the spread of the coronavirus.

In response to these developments, I researched how to prepare an outpatient facility, and recently published a podcast describing the CDC’s guidelines.


Next, I contacted my EMR company to ensure that my staff and I were up to par on how to schedule and perform Telehealth visits.

When I first started playing with the Telehealth module, I researched Medicare’s policies on telemedicine and published a podcast to summarize.

I researched online policies of some insurance companies regarding Telehealth.

I found this:

“In accordance with CMS the eligible Originating Sites are listed below:

  •  The office of a physician or practitioner;
  •  A hospital (inpatient or outpatient);
  •  A critical access hospital (CAH);
  • A rural health clinic (RHC);
  • A federally qualified health center (FQHC);
  •  A hospital-based or critical access hospital-based renal dialysis center (including satellites);
  •  A skilled nursing facility (SNF); and
  •  A community mental health center (CMHC)”

CMS also stated that the below practitioners may bill for Telehealth Services

  • Physician
  • Nurse practitioner
  • Physician assistant
  • Nurse-midwife
  • Clinical nurse specialist
  • Clinical psychologist
  • Clinical social worker
  • Certified Registered Nurse Anesthetists
  • Registered dietitian or nutrition professional

Information obtained from the links below. The Oxford UHC link gives a good description, but it varies by payor.

The codes for the visit are listed on the link below as well as the below modifiers.

Modifier Service

GQ Via Asynchronous Telecommunications systems

GT Via Interactive Audio and Video Telecommunications

Now, some of these may be out of date by the time you read it, so please take it with a grain of salt. Many do not specify if they cover Pain Management services.

Caution, some state that they cover treatment for coronavirus patients, but what about medication refills, new patient visits or post injection follow ups? I encourage you all to call prior to office visits to verify benefits for Telehealth, and inquire about Telehealth copays for Pain related services.

E-VISITS:  In all types of locations including the patient’s home, and in all areas (not just rural), established Medicare patients may have non-face-to-face patient-initiated communications with their doctors without going to the doctor’s office by using online patient portals. These services can only be reported when the billing practice has an established relationship with the patient. For these E-Visits, the patient must generate the initial inquiry and communications can occur over a 7-day period. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. The patient must verbally consent to receive virtual check-in services. The Medicare coinsurance and deductible would apply to these services.

“Medicare Part B also pays for E-visits or patient-initiated online evaluation and management conducted via a patient portal. Practitioners who may independently bill Medicare for evaluation and management visits (for instance, physicians and nurse practitioners) can bill the following codes:

  • 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5″“10 minutes
  • 99422: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11″“ 20 minutes
  • 99423: 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.”


United Health Care and Oxford