Telemedicine Reimbursement Policy: Temporary Update

Effective Date: 
March 1, 2020

EFFECTIVE IMMEDIATELY through at least 90 days after the end of the public health emergency and State of Emergency declared by the Governor, in an effort to connect members with their providers, Horizon BCBSNJ shall expand the use of telemedicine services, for providers, during the current public health emergency, COVID-19. Horizon BCBSNJ shall reimburse the following services in addition to those allowed under the existing Telemedicine Services reimbursement policy.

The following alternative technologies commonly available on smart phones and other devices may be utilized during this public health emergency:

  • Telephonic Services (Phone call with audio only)
  • Telemedicine Services (Both synchronous audio and visual required)
  • Online Patient Portal Communication (Patient initiated virtual check-in for established patients only)

For all of telehealth services rendered, the provider should:

  • Use CMS designated place of service (POS) ‘02’ ,or, ‘11’
  • Append modifier ‘95’ or ‘GT’ where applicable to the appropriate procedure codes listed here.
  • Follow current coding guidelines set forth by the American Medical Association, Current Procedural Terminology Professional Edition and associated publications and services

Temporary extended telemedicine services include: Audiology/tinnitus assessments, Behavioral Health Assessments, Behavioral Health Counseling, Behavioral Health OBAT/MAT services, Hearing aid checks (binaural and monaural), Occupational Therapy (OT) Evaluations, Physical Therapy (PT) Evaluations, Self-Management Education services and Speech Therapy services.

  • Telemedicine service provisions are limited to those services within a provider’s current scope of practice.
  • For telemedicine services rendered by providers participating in the Horizon BCBSNJ Commercial Network, payment will be made at the same rate as that of the existing Professional Agreement Allowances.
  • Member’s cost share (co-payment, deductibles, coinsurance) shall be waived for the duration of the Public Health Emergency regardless of diagnosis, with the following exceptions:
    • ASO groups (only for a diagnosis of COVID-19)
    • When performed by and Out-of-Network provider
  • Authorization and referral requirements are waived for telemedicine services during this temporary expansion.
  • Providers must maintain a complete and accurate record of all telemedicine services performed for Horizon BCBSNJ Commercial members in accordance with applicable law, rules, and regulations, and policies.
  • These expanded services and capabilities are in addition to access that some Horizon BCBSNJ members may currently have on our Horizon CareOnline telehealth platform.

Limitations and Exclusions:
While eligibility for reimbursement is provided under applicable Federal and State laws, regulatory guidance or government mandates, payment determination is subject to, but not limited to:

  • Benefit Limitations
  • The terms of any applicable Horizon BCBSNJ Provider Participation Agreement;
  • Routine claim editing logic, including but not limited to incidental or mutually exclusive logic;
  • Pertinent Horizon BCBSNJ Reimbursement and/or Medical Policies

References:
https://www.nj.gov/governor/news/news/562020/approved/20200322b.shtml
https://www.state.nj.us/dobi/bulletins/blt20_07.pdf

Tikka Attach

Horizon NJ Health Existing and Extended
Telemedicine Policy Codes

Updated on April 8, 2020

Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.

CPT? is a registered mark of the American Medical Association. 1

An Independent Licensee of the
Blue Cross and Blue Shield Association.

Code Service Description
Telemedicine

Reimbursement Policy
Position for HNJH

77427 Radiation treatment management, 5 treatments Extended

90791 Psychiatric diagnostic evaluation Existing

90792 Psychiatric diagnostic evaluation with medical services Existing

90832 Psychotherapy, 30 minutes with patient Existing

90833 Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (add-on code) Existing

90834 Psychotherapy, 45 minutes with patient Existing

90836 Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (add-on code) Existing

90837 Psychotherapy, 60 minutes with patient Existing

90838 Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (add-on code) Existing

90839 Psychotherapy for crisis; first 60 minutes Existing

90845 Psychoanalysis Existing

90846 Family psychotherapy (without the patient present), 50 minutes Existing

90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes Existing

90863 Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (add-on code) Existing

90951 Dialysis services (4 or more physician visits per month), patient younger than 2 years of age Existing

90952 Dialysis services (2-3 physician visits per month), patient younger than 2 years of age Existing

90954 Dialysis services (4 or more physician visits per month), patient 2-11 years of age Existing

90955 Dialysis services (2-3 physician visits per month), patient 2-11 years of age Existing

90957 Dialysis services (4 or more physician visits per month), patient 12-19 years of age Existing

90958 Dialysis services (2-3 physician visits per month), patient 12-19 years of age Existing

90960 Dialysis services (4 or more physician visits per month), patient 20 years of age and older Existing

90961 Dialysis services (2-3 physician visits per month), patient 20 years of age and older Existing

90963 Home dialysis services per month, patient younger than 2 years of age Existing

90964 Home dialysis services per month, patient 2-11 years of age Existing

90965 Home dialysis services per month, patient 12-19 years of age Existing

90966 Home dialysis services per month, patient 20 years of age or older Existing



Horizon NJ Health Existing and Extended
Telemedicine Policy Codes

Updated on April 8, 2020

Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.

CPT? is a registered mark of the American Medical Association. 2

An Independent Licensee of the
Blue Cross and Blue Shield Association.

Code Service Description
Telemedicine

Reimbursement Policy
Position for HNJH

90967 Dialysis services, per day (less than full month service), patient younger than 2 years of age Existing

90968 Dialysis services, per day (less than full month service), patient 2-11 years of age Existing

90969 Dialysis services, per day (less than full month service), patient 12-19 years of age Existing

90970 Dialysis services, per day (less than full month service), patient 20 years of age or older Existing

92507 Treatment Of Speech, Language, Voice, Communication, And/or Auditory Processing Disorder Extended

92520 Laryngeal function studies (ie, aerodynamic testing and acoustic testing) Extended

92521 Evaluation of speech fluency (eg, stuttering, cluttering) Extended

92522 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); Extended

92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) Extended

92524 Behavioral and qualitative analysis of voice and resonance Extended

92526 Treatment of swallowing dysfunction and/or oral function for feeding Extended

92592 Hearing aid check; monaural Extended

92593 Hearing aid check; binaural Extended

92610 Evaluation of oral and pharyngeal swallowing function Extended

92625 Assessment of tinnitus (includes pitch, loudness matching, and masking) Extended

96105 Assessment of expressive and receptive speech with interpretation and report per hour Extended

96116 Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes Existing

96130 Psychological testing evaluation by qualified health care professional, first 60 minutes Extended

96131 Psychological testing evaluation by qualified health care professional, additional 60 minutes Extended

96132 Neuropsychological testing evaluation services by physician or other qualified health care professional, first 60 minutes Extended

96133 Neuropsychological testing evaluation services by physician or other qualified health care professional, additional 60 minutes Extended

96136 Psychological or neuropsychological testing; first 30 minutes Extended

96137 Psychological or neuropsychological testing; additional 30 minutes Extended

96138 Psychological or neuropsychological test administration; first 30 minutes Extended

96139 Psychological or neuropsychological test administration; additional 30 minutes Extended

96160 Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument Existing



Horizon NJ Health Existing and Extended
Telemedicine Policy Codes

Updated on April 8, 2020

Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.

CPT? is a registered mark of the American Medical Association. 3

An Independent Licensee of the
Blue Cross and Blue Shield Association.

Code Service Description
Telemedicine

Reimbursement Policy
Position for HNJH

96161 Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument Existing

97110 Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility Extended

97112 Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes Extended

97116 Walking training to 1 or more areas, each 15 minutes Extended

97129 Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity, direct (one-on-one) patient contact; initial 15 minutes Extended

97130
Therapeutic interventions that focus on cognitive function and compensatory strategies to manage
the performance of an activity, direct (one-on-one) patient contact; each additional 15 minutes
(add-on code)

Extended

97151
Behavior identification assessment, administered by a physician or other qualified health care
professional, each 15 minutes of the physician's or other qualified health care professional's time
face-to-face with patient and/or guardian(s)/caregiver(s)

Extended

97152
Behavior identification-supporting assessment, administered by one technician under the direction
of a physician or other qualified health care professional, face-to-face with the patient, each 15
minutes

Extended

97153
Adaptive behavior treatment by protocol, administered by technician under the direction of a
physician or other qualified health care professional, face-to-face with one patient, each 15
minutes

Extended

97154
Group adaptive behavior treatment by protocol, administered by technician under the direction of
a physician or other qualified health care professional, face-to-face with two or more patients, each
15 minutes

Extended

97155
Adaptive behavior treatment with protocol modification, administered by physician or other
qualified health care professional, which may include simultaneous direction of technician, face-to-
face with one patient, each 15 minutes

Extended

97156
Family adaptive behavior treatment guidance, administered by physician or other qualified health
care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s),
each 15 minutes

Extended

97157
Multiple-family group adaptive behavior treatment guidance, administered by physician or other
qualified health care professional (without the patient present), face-to-face with multiple sets of
guardians/caregivers, each 15 minutes

Extended

97158 Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes Extended

97161 Evaluation of physical therapy, typically 20 minutes Extended

97162 Evaluation of physical therapy, typically 30 minutes Extended

97163 Evaluation of physical therapy, typically 45 minutes Extended

97164 Re-evaluation of physical therapy, typically 20 minutes Extended

97165 Evaluation of occupational therapy, typically 30 minutes Extended

97166 Evaluation of occupational therapy, typically 45 minutes Extended

97167 Evaluation of occupational therapy established plan of care, typically 60 minutes Extended

97168 Re-evaluation of occupational therapy established plan of care, typically 30 minutes Extended



Horizon NJ Health Existing and Extended
Telemedicine Policy Codes

Updated on April 8, 2020

Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.

CPT? is a registered mark of the American Medical Association. 4

An Independent Licensee of the
Blue Cross and Blue Shield Association.

Code Service Description
Telemedicine

Reimbursement Policy
Position for HNJH

97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes Extended

97535
Self-care/home management training and compensatory training, meal preparation, safety
procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-
on-one contact, each 15 minutes

Extended

97750 Physical performance test or measurement with report, each 15 minutes Extended

97755 Assistive technology assessment to enhance functional performance, each 15 minutes Extended

97760 Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes Extended

97761 Training in use of prosthesis for arms and/or legs, per 15 minutes Extended

97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes Existing

97803 Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes Existing

97804 Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes Existing

98960
Education and training for patient self-management by a qualified, nonphysician health care
professional using a standardized curriculum, face-to-face with the patient (could include
caregiver/family) each 30 minutes; individual patient

Extended

98961
Education and training for patient self-management by a qualified, nonphysician health care
professional using a standardized curriculum, face-to-face with the patient (could include
caregiver/family) each 30 minutes; 2-4 patients

Extended

98962
Education and training for patient self-management by a qualified, nonphysician health care
professional using a standardized curriculum, face-to-face with the patient (could include
caregiver/family) each 30 minutes; 5-8 patients

Extended

98966 Telephone assessment and management service, 5-10 minutes of medical discussion Extended

98967 Telephone assessment and management service, 11-20 minutes of medical discussion Extended

98968 Telephone assessment and management service, 21-30 minutes of medical discussion Extended

98970 Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes Extended

98971 Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes Extended

98972 Qualified nonphysician health care professional 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 Extended

99201 New patient office or other outpatient visit, typically 10 minutes Existing

99202 New patient office or other outpatient visit, typically 20 minutes Existing

99203 New patient office or other outpatient visit, typically 30 minutes Existing

99204 New patient office or other outpatient visit, typically 45 minutes Existing

99205 New patient office or other outpatient visit, typically 60 minutes Existing

99211 Established patient office or other outpatient visit, typically 5 minutes Existing



Horizon NJ Health Existing and Extended
Telemedicine Policy Codes

Updated on April 8, 2020

Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.

CPT? is a registered mark of the American Medical Association. 5

An Independent Licensee of the
Blue Cross and Blue Shield Association.

Code Service Description
Telemedicine

Reimbursement Policy
Position for HNJH

99212 Established patient office or other outpatient visit, typically 10 minutes Existing

99213 Established patient office or other outpatient visit, typically 15 minutes Existing

99214 Established patient office or other outpatient, visit typically 25 minutes Existing

99215 Established patient office or other outpatient, visit typically 40 minutes Existing

99217 Hospital observation care on day of discharge Extended

99218 Hospital observation care, typically 30 minutes Extended

99219 Hospital observation care, typically 50 minutes Extended

99220 Hospital observation care, typically 70 minutes Extended

99221 Initial hospital inpatient care, typically 30 minutes per day Extended

99222 Initial hospital inpatient care, typically 50 minutes per day Extended

99223 Initial hospital inpatient care, typically 70 minutes per day Extended

99224 Subsequent observation care, typically 15 minutes per day Extended

99225 Subsequent observation care, typically 25 minutes per day Extended

99226 Subsequent observation care, typically 35 minutes per day Extended

99231 Subsequent hospital inpatient care, typically 15 minutes per day Existing

99232 Subsequent hospital inpatient care, typically 25 minutes per day Existing

99233 Subsequent hospital inpatient care, typically 35 minutes per day Existing

99234 Hospital observation or inpatient care low severity, 40 minutes per day Extended

99235 Hospital observation or inpatient care moderate severity, 50 minutes per day' Extended

99236 Hospital observation or inpatient care high severity, 55 minutes per day Extended

99238 Hospital discharge day management, 30 minutes or less Extended

99239 Hospital discharge day management, more than 30 minutes Extended

99241 Patient office consultation, typically 15 minutes Existing

99242 Patient office consultation, typically 30 minutes Existing

99243 Patient office consultation, typically 40 minutes Existing

99244 Patient office consultation, typically 60 minutes Existing



Horizon NJ Health Existing and Extended
Telemedicine Policy Codes

Updated on April 8, 2020

Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.

CPT? is a registered mark of the American Medical Association. 6

An Independent Licensee of the
Blue Cross and Blue Shield Association.

Code Service Description
Telemedicine

Reimbursement Policy
Position for HNJH

99245 Patient office consultation, typically 80 minutes Existing

99251 Inpatient hospital consultation, typically 20 minutes Existing

99252 Inpatient hospital consultation, typically 40 minutes Existing

99253 Inpatient hospital consultation, typically 55 minutes Existing

99254 Inpatient hospital consultation, typically 80 minutes Existing

99255 Inpatient hospital consultation, typically 110 minutes Existing

99281 Emergency department visit, self limited or minor problem Extended

99282 Emergency department visit, low to moderately severe problem Extended

99283 Emergency department visit, moderately severe problem Extended

99284 Emergency department visit, problem of high severity Extended

99285 Emergency department visit, problem with significant threat to life or function Extended

99291 Critical care delivery critically ill or injured patient, first 30-74 minutes Extended

99292 Critical care delivery critically ill or injured patient Extended

99304 Initial nursing facility visit, typically 25 minutes per day Extended

99305 Initial nursing facility visit, typically 35 minutes per day Extended

99306 Initial nursing facility visit, typically 45 minutes per day Extended

99307 Subsequent nursing facility visit, typically 10 minutes per day Existing

99308 Subsequent nursing facility visit, typically 15 minutes per day Existing

99309 Subsequent nursing facility visit, typically 25 minutes per day Existing

99310 Subsequent nursing facility visit, typically 35 minutes per day Existing

99315 Nursing facility discharge day management, 30 minutes or less Extended

99316 Nursing facility discharge management, more than 30 minutes Extended

99327 New patient assisted living visit, typically 60 minutes Extended

99328 New patient assisted living visit, typically 75 minutes Extended

99334 Established patient assisted living visit, typically 15 minutes Extended

99335 Established patient assisted living visit, typically 25 minutes Extended



Horizon NJ Health Existing and Extended
Telemedicine Policy Codes

Updated on April 8, 2020

Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.

CPT? is a registered mark of the American Medical Association. 7

An Independent Licensee of the
Blue Cross and Blue Shield Association.

Code Service Description
Telemedicine

Reimbursement Policy
Position for HNJH

99336 Established patient assisted living visit, typically 40 minutes Extended

99337 Established patient assisted living visit, typically 60 minutes Extended

99341 New patient home visit, typically 20 minutes Extended

99342 New patient home visit, typically 30 minutes Extended

99343 New patient home visit, typically 45 minutes Extended

99344 New patient home visit, typically 60 minutes Extended

99345 New patient home visit, typically 75 minutes Extended

99347 Established patient home visit, typically 15 minutes Extended

99348 Established patient home visit, typically 25 minutes Extended

99349 Established patient home visit, typically 40 minutes Extended

99350 Established patient home visit, typically 60 minutes Extended

99354 Prolonged office or other outpatient service first hour Existing

99355 Prolonged office or other outpatient service each 30 minutes beyond first hour Existing

99356 Prolonged inpatient or observation hospital service first hour Existing

99357 Prolonged inpatient or observation hospital service each 30 minutes beyond first hour Existing

99381 Initial new patient preventive medicine evaluation infant younger than 1 year Extended

99382 Initial new patient preventive medicine evaluation, age 1 through 4 years Extended

99383 Initial new patient preventive medicine evaluation, age 5 through 11 years Extended

99384 Initial new patient preventive medicine evaluation, age 12 through 17 years Extended

99385 Initial new patient preventive medicine evaluation age 18-39 years Extended

99386 Initial new patient preventive medicine evaluation age 40-64 years Extended

99387 Initial new patient preventive medicine evaluation, age 65 years and older Extended

99391 Established patient periodic preventive medicine examination infant younger than 1 year Extended

99392 Established patient periodic preventive medicine examination, age 1 through 4 years Extended

99393 Established patient periodic preventive medicine examination, age 5 through 11 years Extended

99394 Established patient periodic preventive medicine examination, age 12 through 17 years Extended



Horizon NJ Health Existing and Extended
Telemedicine Policy Codes

Updated on April 8, 2020

Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.

CPT? is a registered mark of the American Medical Association. 8

An Independent Licensee of the
Blue Cross and Blue Shield Association.

Code Service Description
Telemedicine

Reimbursement Policy
Position for HNJH

99395 Established patient periodic preventive medicine examination age 18-39 years Extended

99396 Established patient periodic preventive medicine examination age 40-64 years Extended

99397 Established patient periodic preventive medicine examination, age 65 years and older Extended

99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes Existing

99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes Existing

99408 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes Existing

99409 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes Existing

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 Extended

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 Extended

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 Extended

99441 Physician telephone patient service, 5-10 minutes of medical discussion Extended

99442 Physician telephone patient service, 11-20 minutes of medical discussion Extended

99443 Physician telephone patient service, 21-30 minutes of medical discussion Extended

99468 Initial inpatient hospital critical care of newborn, 28 days of age or younger, per day Extended

99469 Subsequent inpatient hospital critical care of newborn, 28 days of age or younger, per day Extended

99471 Initial inpatient hospital critical care of infant or young child, 29 days through 24 months of age, per day Extended

99472 Subsequent inpatient hospital critical care of infant or young child, 29 days through 24 months of age, per day Extended

99475 Initial inpatient hospital critical care of infant or young child, 2 through 5 years of age, per day Extended

99476 Subsequent inpatient hospital critical care of infant or young child, 2 through 5 years of age, per day Extended

99477 Initial intensive care of newborn, 28 days of age or younger, per day Extended

99478 Subsequent intensive care of recovering low birth weight infant, per day Extended

99479 Subsequent intensive care of recovering low birth weight infant, per day Extended

99480 Subsequent intensive care of recovering low birth weight infant, per day Extended

99483 Assessment of and care planning for patient with impaired thought processing, typically 50 minutes Extended

99495 Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge Existing

99496 Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge Existing



Horizon NJ Health Existing and Extended
Telemedicine Policy Codes

Updated on April 8, 2020

Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.

CPT? is a registered mark of the American Medical Association. 9

An Independent Licensee of the
Blue Cross and Blue Shield Association.

Code Service Description
Telemedicine

Reimbursement Policy
Position for HNJH

99497 Advance care planning by the physician or other qualified health care professional Existing

99498 Advance care planning by the physician or other qualified health care professional (add-on code) Existing

0362T Behavior identification supporting assessment for patient exhibiting destructive behavior, each 15 minutes of technicians' face-to-face time Extended

0373T Adaptive behavior treatment with protocol modification for patient exhibiting destructive behavior, each 15 minutes of technicians' face-to-face time Extended

90887 HF Explanation of psychiatric, medical examinations, procedures, and data to other than patient; substance abuse program Extended

90887 UC Explanation of psychiatric, medical examinations, procedures, and data to other than patient; Medicaid level of care 12 Extended

G0108 Diabetes outpatient self-management training services, individual, per 30 minutes Existing

G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes Existing

G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen, each 15 minutes Existing

G0296 Counseling visit to discuss need for lung cancer screening (LDCT) using low dose CT scan (service is for eligibility determination and shared decision making) Existing

G0396 Alcohol and/or substance (other than tobacco) abuse structured assessment (eg, AUDIT, DAST). and brief intervention 15 to 30 minutes Existing

G0397 Alcohol and/or substance (other than tobacco) abuse structured assessment (eg, AUDIT, DAST). and intervention, greater than 30 minutes Existing

G0406 Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth Existing

G0407 Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth Existing

G0408 Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth Existing

G0420 Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour Existing

G0421 Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour Existing

G0425 Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth Existing

G0426 Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth Existing

G0427 Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth Existing

G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes Extended

G0445 High intensity behavioral counseling, 30 minutes Existing

G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes Existing

G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services (add-on code) Existing

G0508 Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth Existing

G0509 Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth Existing



Horizon NJ Health Existing and Extended
Telemedicine Policy Codes

Updated on April 8, 2020

Please note: Additional benefits may be available as codes are subject
to change frequently based on evolving guidance from Federal and State agencies.

CPT? is a registered mark of the American Medical Association. 10

An Independent Licensee of the
Blue Cross and Blue Shield Association.

Code Service Description
Telemedicine

Reimbursement Policy
Position for HNJH

G0513
Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the
office or other outpatient setting requiring direct patient contact beyond the usual service; first 30
minutes (add-on code)

Existing

G0514
Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the
office or other outpatient setting requiring direct patient contact beyond the usual service; each
additional 30 minutes (add-on code)

Existing

G2010 Remote evaluation of recorded video and/or images submitted by an established patient Extended

G2012 Brief communication technology-based service, e.g., virtual check-in, 5-10 minutes of medical discussion Extended

G2061 Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes Extended

G2062 Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes Extended

G2063 Qualified nonphysician qualified health care professional assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes Extended

H0001 Alcohol and drug assessment Extended

H0002 Behavioral health screening to determine eligibility for admission to treatment program Extended

H0004 Behavioral health counseling and therapy, per 15 minutes Extended

H0006 HF Navigator services (Maintenance) Extended

H0006 HF HG Navigator psychosocial assessment & patient-specific Treatment plan development (Initiation) Extended

H0006 HF SU Navigator services (Stabilization) Extended

H0014 Alcohol and/or drug services; ambulatory detoxification Extended

H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) Extended

H0020 HF Methadone (per diem) Extended

H0020 HF 26 Methadone (bundled) Extended

H0032 Mental Health service plan development by a non-physician, per 15 minutes Extended

H0033 HF non-Methadone (per diem) Extended

H0033 HF 26 non-Methadone (bundled) Extended

H0035 Mental health partial hospitalization, treatment, less than 24 hours Extended

H0047 Alcohol and/or other drug abuse services, not otherwise specified Extended

H2036 HF Alcohol and/or other drug treatment program, per diem; substance abuse program Extended