New Telehealth CPT Codes Introduced

CMS has added several new Current Procedural Terminology (CPT) codes to expand telehealth services:

  • CPT 98016: This code replaces HCPCS code G2012, covering brief communication technology-based services.

  • HCPCS Codes G0539–G0543: Established for caregiver training services, these codes can be billed when training is provided via telehealth.

  • HCPCS Code G0560: Introduced for safety planning interventions for patients in crisis, this code is now payable under the PFS when furnished via telehealth.

Extension of Telehealth Flexibilities

Several telehealth flexibilities have been extended through September 30, 2025:

  • Geographic and Site Restrictions: Medicare patients can continue to receive telehealth services in their homes, regardless of geographic location.

  • Audio-Only Services: Audio-only telehealth services remain covered for non-behavioral/mental health care.

  • Provider Eligibility: All eligible Medicare providers can furnish telehealth services. (Source: Centers for Medicare & Medicaid Services+16telehealth.hhs.gov+16telehealth.hhs.gov+16)

  • FQHCs and RHCs: Federally Qualified Health Centers and Rural Health Clinics can serve as distant site providers for non-behavioral/mental telehealth services.

Virtual Direct Supervision

CMS has extended the allowance for virtual direct supervision through December 31, 2025. This permits supervising practitioners to be immediately available through real-time audio and video technology when direct supervision is required.

Telehealth Originating Site Facility Fee Update

For CY 2025, the payment amount for HCPCS code Q3014 (Telehealth originating site facility fee) is set at 80% of the lesser of the actual charge or $31.01. This reflects a 3.5% increase from the previous year.

Implications for Pharmacists and Healthcare Providers

The 2025 PFS updates present opportunities and considerations for pharmacists and healthcare providers:

  • Billing for Telehealth Services: With new CPT and HCPCS codes, providers can expand their telehealth offerings and ensure appropriate reimbursement.

  • Caregiver Training: The inclusion of caregiver training services in telehealth billing allows pharmacists to support patient care more comprehensively.

  • Compliance and Documentation: Providers must stay informed about coding changes and ensure accurate documentation to comply with CMS requirements.

Preparing for Implementation

To effectively navigate these changes:

  • Stay Informed: Regularly review CMS updates and resources to remain current on telehealth policies.

  • Educate Staff: Ensure that all team members understand the new codes and billing procedures.

  • Evaluate Technology: Assess and upgrade telehealth platforms to meet CMS standards and patient needs. (Source: Michigan State Medical Society)

  • Engage Patients: Communicate with patients about telehealth options and any changes to services or billing.

The 2025 Medicare Physician Fee Schedule introduces significant changes to telehealth services, offering expanded opportunities for pharmacists and healthcare providers. By understanding and adapting to these updates, providers can enhance patient care and optimize reimbursement strategies.

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