Well visits via Telehealth

Is anyone considering well visits via Telehealth? Is there a limitation in billing these as preventive visits as there is not a complete physical exam? We are not really doing an “age and gender appropriate physical exam” via Telehealth. Thoughts?

Some local practices are doing a modified telehealth and car visit.
They get the history, developmental history via telehealth, then drive to the parking lot and get limited vital signs, limited phyiscal exam in car and then give vaccines.
Certainly not ideal but keeping out of the office.

Very interesting. Will float to my partners

What codes would be reimbursed for this type of visit? Would telehealth pay for preventative medicine codes?

That is creative but still the doctor gets exposed.

To my knowledge, there is no way to bill a well-visit via telehealth.

We are using Kids Doc and it’s working great. Patients are very appreciative. All sick visits and phone advice is done by the doctor this way. We schedule them, register pt, doctor calls through the app. We bill 99213 or higher with modifier GT. Pays the same as an office visit.
We are canceling after hours service, extending hours so docs can do Kids Doc up to 10pm.
Collect copay and balances when you make the appointment.
Post on social media and email and text all patients about virtual visits.

We are doing only well visits and newborns in the office.

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Look under the coding section…there are two great resources from PediaTrust and PCC with all the necessary coding info needed

Would you mind to send me the info on Kids Doc, so that I can check into this telehealth platform?
My email is : bstory@catawbapediatrics.net Thank you for your help.

Check out this article: http://www.telemedmag.com/article/telemedicine-physical-better-think/

the boogyman here is payment- i have yet to see anyone offer payment for a telehealth PE. we are considering doing “half” by having the talking/CHADIS part by telehealth now, then finishing with the PE/screenings-hear,vision/bloodwork and vaccines at a later date in a sort of in and out clinic style. but we would be limited in probably billing these at the time of seeing in person.

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We found out on Monday what our telehealth reimbursement rate was from our largest payer and it was a THIRD of the normal in-person rate. I was on the phone and emails immediately. The insurance companies want to act like they’re doing a great service by relaxing the rules, but they’re also doing no help by relaxing reimbursements for telehealth. They were only allowing us to submit 99421-99423.
It took a lot of lobbying to many different people, but yesterday, they put out an update allowing e/m codes to be submitted, but also stated, “these will not be reimbursed at the same in-person rate.” So although we won a minor victory with them allowing e/m codes, we still have to fight for better reimbursement. The Nebraska Medical Association is lobbying hard and pushing the Governor to issue an executive order mandating all payers reimburse at an in-person rate. This is an uphill battle.

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Everyone should heed this experience…if the claims are not getting paid as expected, get in touch and fight for parity payments…

If you have RVU-based contracts, which many of you do, I’d love to understand how and why the payors would be able to pay less than the full value of the RVU service.

Health insurance companies are behaving like organized crime.


CT BCBS paying one fixed rate for telehealth about 1/3 of what we should get for the average visit. In the past they have been unreachable, non negotiable and can’t get a rep. Put in a hassle factor form but anyone in CT have a contact?!

Any insurances paying for Telehealth well visits ?

Yes - it’s very regional. VT BCBS, for example, is paying for well visits via telehealth.

We have two local payers who have agreed to cover well visits via telehealth, nothing from the national payers yet. The Governor (Mass) is requiring payers to reimburse all medically necessary, clinically appropriate visits via telehealth at the same rate as in person visits.


We have been doing “WCC” via telehealth in my San Antonio practice for 9 days now. We made the decision expecting to not get paid. We had a robust discussion about R/B of doing so and we fell on the side of doing them. Every kid 4m and older is telehealth only. Car visits for shots and any f/u exam needed. We can discuss the merits of it elsewhere, but the financial plan is as follows.

We have worked creatively to identify an algorithm to follow to identify best methods of payment, including 9938X and 9921X. I am in Texas and there is payment parity for all fully funded/non-ERISA/DOI-governed plans for telehealth WCC, according to our local state reps. But that is clearly a minority. The rest we are investigating and calling on and getting reference numbers to back us up. We have held claims in an effort to give state and federal gov’t time to get things together. Yes, we may be exposed to audits. We know that.

If you want telehealth parity, my impression is that nothing is going to work until we get a federal mandate that telehealth WCC will be covered with parity. I think it is up to the AAP lobby and whatever national pull we each have. The states are going to wash their hands for all non-state regulated plans, nor do I know if they even have authority to mandate higher anyways.


Virginia Anthem is telling parents (and providers that bother to call) that they will cover all preventive health codes delivered via telehealth.