We support and encourage you to provide care for new and established patients through any means (telephone, video or in person), from any location (home or office) and at any time, as long as the care is clinically appropriate, properly documented and follows appropriate billing procedures.
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Payment for services is based on the lesser of the CO DOWC Fee Schedule or the billed amount minus any contractual discounts, if applicable. Payment for telehealth services is based on the non-facility RBRVS unit value for the CPT code multiplied by the appropriate conversion factor, but the additional $5.00 transmission fee is not payable.
If telephone services are utilized, the coding is based on time and is not considered telehealth. If telehealth (video and audio) is utilized, refer to the E&M codes under telehealth below.
The fee schedule is substantially lower utilizing phone services only.
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General Medicine/Occupational Medicine
Telehealth E&M services (video and audio)
Add the modifier -95 to the E&M code and use place of service (location code) 02
99201 – 99215 Office or other outpatient visits
99241 – 99245 Consultations
Physicians: Telephone E&M services (audio only)
Use the appropriate place of service code. No modifier is required.
99441 5 – 10 minutes of medical discussion with a physician*
99442 11 – 20 minutes of medical discussion with a physician
99443 21 – 30 minutes of medical discussion with a physician
Non-physician practitioners: Telephone E&M services (audio only)
Use the appropriate place of service code. No modifier is required.
98966 5 – 10 minutes of medical discussion with a non-physician practitioner*
98967 11 – 20 minutes of medical discussion with a non-physician practitioner
98968 21 – 30 minutes of medical discussion with a non-physician practitioner
*As listed in CO DOWC Rule 16-2(N), page 4
Psychiatric Psychological Services
Physicians: Telephone E&M services (audio only)
Use the appropriate place of service code. No modifier is required.
99441 5 – 10 minutes of medical discussion with a physician*
99442 11 – 20 minutes of medical discussion with a physician
99443 21 – 30 minutes of medical discussion with a physician
Non-physician practitioners: Telephone E&M services (audio only)
Use the appropriate place of service code. No modifier is required.
98966 5 – 10 minutes of medical discussion with a non-physician practitioner*
98967 11 – 20 minutes of medical discussion with a non-physician practitioner
98968 21 – 30 minutes of medical discussion with a non-physician practitioner
*As listed in CO DOWC Rule 16-2(N), page 4
Telehealth Psychological services (video and audio)
Add the modifier -95 to the E&M code and use place of service (location code) 02
96150 – 96152 Individual health and behavior assessment and intervention
90832 – 90838 Individual psychotherapy
90791 – 90792 Psychiatric diagnostic interview examination
96116 Neurobehavioral status examination
Physical Medicine and Rehabilitation
Telephone E&M services (audio only)
Use the appropriate place of service code. No modifier is required.
98966 5 – 10 minutes of medical discussion with a non-physician practitioner*
98967 11 – 20 minutes of medical discussion with a non-physician practitioner
98968 21 – 30 minutes of medical discussion with a non-physician practitioner
*As listed in CO DOWC Rule 16-2(N), page 4
Telehealth E&M services (video and audio) for rehabilitation
Add the modifier -95 to the E&M code and use place of service (location code) 02
97161 – 97164 Physical therapy evaluations
97165 – 97168 Occupational therapy evaluations
97169 – 97172 Athletic training evaluations
Therapy codes for physical therapy, occupational therapy, chiropractic care and athletic training
Add the modifier -95 to the E&M code and use place of service (location code) 02
97110 Therapeutic exercises to develop strength, endurance, range of motion, flexibility
97112 Neuromuscular re-education
97116 Gait training, including stair climbing
97530 Direct one-on-one patient contact; use of dynamic activities to improve function
97535 Self-care/home management training (activities of daily living, etc.)
For billing and coding assistance, contactbillingsuccess@pinnacol.com or 303.361.4940.
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