CA: New Telehealth Billing Requirements for 2025

February 6, 2025 10 min read

By: the daisyNews Team

CA: New Telehealth Billing Requirements for 2025

As part of the updates to the Physician and Non-Physician Practitioner portion of California’s Official Medical Fee Schedule (OMFS) for workers’ comp, the state’s Division of Workers’ Compensation (CA DWC) made significant changes to telehealth billing effective for dates of service on or after February 1, 2025.

The telehealth billing changes align the CA OMFS with recent updates to the Medicare telehealth payment rules and include the following:

Telehealth billing code modifiers changes
Audio-only technology adoption for all services
Removal of three telehealth billing codes
Adoption of non-payable telehealth codes with Status Indicator ‘I’

Below are further details and a complete list of allowable telehealth billing codes. As always, daisyBill’s OMFS Calculator and billing software reflect the updates for the applicable dates of service.

CA Billing Code Modifiers for Telehealth

To align the OMFS with changes to Medicare (as required by California Labor Code Section 5307.1), the CA DWC posted its formal update order effective February 1, 2025, and announced this update in a 2024 Newsline.

The DWC order updates the California Code of Regulations (CCR) Section 9789.19.(l). The update changes telehealth billing instructions as follows:

Modifier 93—When telehealth treatment is delivered via two-way, real-time, interactive audio-only communication technology, providers must append modifier 93 to the applicable procedure code.
Modifier 95—When telehealth treatment is delivered via two-way, real-time, interactive audio-video communication technology, providers must append modifier 95 to the applicable procedure code.

These modifiers do not increase or decrease the reimbursement amounts for any telehealth procedure code; they simply document that the provider delivered the service via telehealth and specify the technology utilized.

Audio-Only: Acceptable for All Telehealth Treatment

Previously, many telehealth services mandated using audio-video technology (as opposed to audio-only technology) for designated telehealth.

As of February 1, per the new Medicare Final Rule regarding telehealth, audio-only technology meets the requirements for all procedure codes in the telehealth list (emphasis ours):

“...an interactive telecommunications system may include two-way, real-time, audio-only communication technology for any telehealth service provided to a patient in their home if the distant site provider is technically capable of using an audio-video telehealth system, but the patient isn’t capable of, or doesn’t consent to, using video technology.”

The column “Can Audio-only Interaction Meet the Requirements?” in the previous Medicare List of Telehealth Services is no longer applicable.

Non-Payable Telehealth Codes

The Telehealth Codes listed in the table below are not payable because they have a status indicator of ‘I.’ Per CCR §9789.12.3(c)(1), Current Procedural Terminology (CPT) codes with Status Code I, where Medicare uses another CPT code for reporting and payment for these services, shall be reimbursed according to that code.

Providers should use the appropriate Evaluation and Management (E/M) billing codes instead of the following codes:

Telehealth Codes: Not Payable (Use Appropriate E/M Codes Instead)	Procedure Description
98000	Synch audio-video new sf 15
98001	Synch audio-video new low 30
98002	Synch audio-video new mod 45
98003	Synch audio-video new hi 60
98004	Synch audio-video est sf 10
98005	Synch audio-video est low 20
98006	Synch audio-video est mod 30
98007	Synch audio-video est hi 40
98008	Synch audio-only new sf 15
98009	Synch audio-only new low 30
98010	Synch audio-only new mod 45
98011	Synch audio-only new high 60
98012	Synch audio-only est sf 10
98013	Synch audio-only est low 20
98014	Synch audio-only est mod 30
98015	Synch audio-only est high 40

Telehealth Codes Deleted

The CPT codes in the table below were deleted from the CMS List of Telehealth Services. Effective February 1st, the CA OMFS no longer lists these codes as payable.

Deleted Procedure Code	Procedure Description
CPT 99441	Phone e/m phys/qhp 5-10 min
CPT 99442	Phone e/m phys/qhp 11-20 min
CPT 99443	Phone e/m phys/qhp 21-30 min

Full Telehealth Code List

Below is the complete Medicare list of telehealth codes the CA DWC adopted for California workers’ comp effective February 1.

As in previous years, daisyNews reminds providers that only the CA DWC determines compliant use of telehealth for California workers’ comp. Any instructions from claims administrators that contradict CA DWC regulations are not valid. Denials of payment based on claims administrator policies that contradict CA DWC regulations are improper, and providers should submit Second Review appeals accordingly.

For any questions about billing for telehealth services, contact our experts. We’re here to help!

Procedure Code	Procedure Description
0362T	Bhv id suprt assmt ea 15 min
0373T	Adapt bhv tx ea 15 min
0591T	Hlth&wb coaching indiv 1st
0592T	Hlth&wb coaching indiv f-up
0593T	Hlth&wb coaching indiv group
77427	Radiation tx management x5
90785	Psytx complex interactive
90791	Psych diagnostic evaluation
90792	Psych diag eval w/med srvcs
90832	Psytx w pt 30 minutes
90833	Psytx w pt w e/m 30 min
90834	Psytx w pt 45 minutes
90836	Psytx w pt w e/m 45 min
90837	Psytx w pt 60 minutes
90838	Psytx w pt w e/m 60 min
90839	Psytx crisis initial 60 min
90840	Psytx crisis ea addl 30 min
90845	Psychoanalysis
90846	Family psytx w/o pt 50 min
90847	Family psytx w/pt 50 min
90853	Group psychotherapy
90875	Psychophysiological therapy
90901	Biofeedback train any meth
90951	Esrd serv 4 visits p mo <2yr
90952	Esrd serv 2-3 vsts p mo <2yr
90953	Esrd serv 1 visit p mo <2yrs
90954	Esrd serv 4 vsts p mo 2-11
90955	Esrd srv 2-3 vsts p mo 2-11
90956	Esrd srv 1 visit p mo 2-11
90957	Esrd srv 4 vsts p mo 12-19
90958	Esrd srv 2-3 vsts p mo 12-19
90959	Esrd serv 1 vst p mo 12-19
90960	Esrd srv 4 visits p mo 20+
90961	Esrd srv 2-3 vsts p mo 20+
90962	Esrd serv 1 visit p mo 20+
90963	Esrd home pt serv p mo <2yrs
90964	Esrd home pt serv p mo 2-11
90965	Esrd home pt serv p mo 12-19
90966	Esrd home pt serv p mo 20+
90967	Esrd svc pr day pt <2
90968	Esrd svc pr day pt 2-11
90969	Esrd svc pr day pt 12-19
90970	Esrd svc pr day pt 20+
92002	Eye exam new patient
92004	Eye exam new patient
92012	Eye exam establish patient
92014	Eye exam&tx estab pt 1/>vst
92507	Speech/hearing therapy
92508	Speech/hearing therapy
92521	Evaluation of speech fluency
92522	Evaluate speech production
92523	Speech sound lang comprehen
92524	Behavral qualit analys voice
92526	Oral function therapy
92550	Tympanometry & reflex thresh
92552	Pure tone audiometry air
92553	Audiometry air & bone
92555	Speech threshold audiometry
92556	Speech audiometry complete
92557	Comprehensive hearing test
92563	Tone decay hearing test
92565	Stenger test pure tone
92567	Tympanometry
92568	Acoustic refl threshold tst
92570	Acoustic immitance testing
92587	Evoked auditory test limited
92588	Evoked auditory tst complete
92601	Cochlear implt f/up exam <7
92602	Reprogram cochlear implt <7
92603	Cochlear implt f/up exam 7/>
92604	Reprogram cochlear implt 7/>
92607	Ex for speech device rx 1hr
92608	Ex for speech device rx addl
92609	Use of speech device service
92610	Evaluate swallowing function
92625	Tinnitus assessment
92626	Eval aud funcj 1st hour
92627	Eval aud funcj ea addl 15
93750	Interrogation vad in person
93797	Cardiac rehab
93798	Cardiac rehab/monitor
94002	Vent mgmt inpat init day
94003	Vent mgmt inpat subq day
94004	Vent mgmt nf per day
94005	Home vent mgmt supervision
94625	Phy/qhp op pulm rhb w/o mntr
94626	Phy/qhp op pulm rhb w/ mntr
94664	Evaluate pt use of inhaler
95970	Alys npgt w/o prgrmg
95971	Alys smpl sp/pn npgt w/prgrm
95972	Alys cplx sp/pn npgt w/prgrm
95983	Alys brn npgt prgrmg 15 min
95984	Alys brn npgt prgrmg addl 15
96105	Assessment of aphasia
96110	Developmental screen w/score
96112	Devel tst phys/qhp 1st hr
96113	Devel tst phys/qhp ea addl
96116	Nubhvl xm phys/qhp 1st hr
96121	Nubhvl xm phy/qhp ea addl hr
96125	Cognitive test by hc pro
96127	Brief emotional/behav assmt
96130	Psycl tst eval phys/qhp 1st
96131	Psycl tst eval phys/qhp ea
96132	Nrpsyc tst eval phys/qhp 1st
96133	Nrpsyc tst eval phys/qhp ea
96136	Psycl/nrpsyc tst phy/qhp 1st
96137	Psycl/nrpsyc tst phy/qhp ea
96138	Psycl/nrpsyc tech 1st
96139	Psycl/nrpsyc tst tech ea
96156	Hlth bhv assmt/reassessment
96158	Hlth bhv ivntj indiv 1st 30
96159	Hlth bhv ivntj indiv ea addl
96160	Pt-focused hlth risk assmt
96161	Caregiver health risk assmt
96164	Hlth bhv ivntj grp 1st 30
96165	Hlth bhv ivntj grp ea addl
96167	Hlth bhv ivntj fam 1st 30
96168	Hlth bhv ivntj fam ea addl
96170	Hlth bhv ivntj fam wo pt 1st
96171	Hlth bhv ivntj fam w/o pt ea
96202	Hlth bhv intj ind 1st 30
96203	Hlth bhv ivntj ind ea addl
97110	Therapeutic exercises
97112	Neuromuscular reeducation
97116	Gait training therapy
97129	Ther ivntj 1st 15 min
97130	Ther ivntj ea addl 15 min
97150	Group therapeutic procedures
97151	Bhv id assmt by phys/qhp
97152	Bhv id suprt assmt by 1 tech
97153	Adaptive behavior tx by tech
97154	Grp adapt bhv tx by tech
97155	Adapt behavior tx phys/qhp
97156	Fam adapt bhv tx gdn phy/qhp
97157	Mult fam adapt bhv tx gdn
97158	Grp adapt bhv tx by phy/qhp
97161	Pt eval low complex 20 min
97162	Pt eval mod complex 30 min
97163	Pt eval high complex 45 min
97164	Pt re-eval est plan care
97165	Ot eval low complex 30 min
97166	Ot eval mod complex 45 min
97167	Ot eval high complex 60 min
97168	Ot re-eval est plan care
97530	Therapeutic activities
97535	Self care mngment training
97537	Community/work reintegration
97542	Wheelchair mngment training
97550	Caregiver training; initial 30 min
97551	Caregiver training: ea addnl 30 min
97552	Group caregiver training
97750	Physical performance test
97755	Assistive technology assess
97760	Orthotic mgmt&traing 1st enc
97761	Prosthetic traing 1st enc
97763	Orthc/prostc mgmt sbsq enc
97802	Medical nutrition indiv in
97803	Med nutrition indiv subseq
97804	Medical nutrition group
98960	Self-mgmt educ & train 1 pt
98961	Self-mgmt educ/train 2-4 pt
98962	Self-mgmt educ/train 5-8 pt
98966	Hc pro phone call 5-10 min
98967	Hc pro phone call 11-20 min
98968	Hc pro phone call 21-30 min
99202	Office/outpatient visit new
99203	Office/outpatient visit new
99204	Office/outpatient visit new
99205	Office/outpatient visit new
99211	Office/outpatient visit est
99212	Office/outpatient visit est
99213	Office/outpatient visit est
99214	Office/outpatient visit est
99215	Office/outpatient visit est
99221	Initial hospital care
99222	Initial hospital care
99223	Initial hospital care
99231	Subsequent hospital care
99232	Subsequent hospital care
99233	Subsequent hospital care
99234	Observ/hosp same date
99235	Observ/hosp same date
99236	Observ/hosp same date
99238	Hospital discharge day
99239	Hospital discharge day
99281	Emergency dept visit
99282	Emergency dept visit
99283	Emergency dept visit
99284	Emergency dept visit
99285	Emergency dept visit
99291	Critical care first hour
99292	Critical care addl 30 min
99304	Nursing facility care init
99305	Nursing facility care init
99306	Nursing facility care init
99307	Nursing fac care subseq
99308	Nursing fac care subseq
99309	Nursing fac care subseq
99310	Nursing fac care subseq
99315	Nursing fac discharge day
99316	Nursing fac discharge day
99341	Home visit new patient
99342	Home visit new patient
99344	Home visit new patient
99345	Home visit new patient
99347	Home visit est patient
99348	Home visit est patient
99349	Home visit est patient
99350	Home visit est patient
99406	Behav chng smoking 3-10 min
99407	Behav chng smoking > 10 min
99468	Neonate crit care initial
99469	Neonate crit care subsq
99471	Ped critical care initial
99472	Ped critical care subsq
99473	Self-meas bp pt educaj/train
99475	Ped crit care age 2-5 init
99476	Ped crit care age 2-5 subsq
99477	Init day hosp neonate care
99478	Ic lbw inf < 1500 gm subsq
99479	Ic lbw inf 1500-2500 g subsq
99480	Ic inf pbw 2501-5000 g subsq
99483	Assmt & care pln pt cog imp
99495	Trans care mgmt 14 day disch
99496	Trans care mgmt 7 day disch
99497	Advncd care plan 30 min
99498	Advncd care plan addl 30 min
G0108	Diab manage trn per indiv
G0109	Diab manage trn ind/group
G0011	Ind couns for PrEP by QHP, 15-30 min
G0013	Initial or contd couns for PrEP by clinical staff, 30 min
G0136	Admin SDOH risk assmt tool, 5-15 min
G0270	Mnt subs tx for change dx
G0296	Visit to determ ldct elig
G0316	Prolonged hospital inpatient or observation care
G0317	Prolonged nursing facility evaluation and management service
G0318	Prolonged home or residence evaluation and management
G0396	Alcohol/subs interv 15-30mn
G0397	Alcohol/subs interv >30 min
G0406	Inpt/tele follow up 15
G0407	Inpt/tele follow up 25
G0408	Inpt/tele follow up 35
G0410	Grp psych partial hosp 45-50
G0420	Ed svc ckd ind per session
G0421	Ed svc ckd grp per session
G0422	Intens cardiac rehab w/exerc
G0423	Intens cardiac rehab no exer
G0425	Inpt/ed teleconsult30
G0426	Inpt/ed teleconsult50
G0427	Inpt/ed teleconsult70
G0438	Ppps, initial visit
G0439	Ppps, subseq visit
G0442	Annual alcohol screen 15 min
G0443	Brief alcohol misuse counsel
G0444	Depression screen annual
G0445	High inten beh couns std 30m
G0446	Intens behave ther cardio dx
G0447	Behavior counsel obesity 15m
G0459	Telehealth inpt pharm mgmt
G0506	Comp asses care plan ccm svc
G0508	Crit care telehea consult 60
G0509	Crit care telehea consult 50
G0513	Prolong prev svcs, first 30m
G0514	Prolong prev svcs, addl 30m
G2086	Off base opioid tx 70min
G2087	Off base opioid tx, 60 m
G2088	Off base opioid tx, add30
G2211	Complex E/M visit add on
G2212	Prolong outpt/office vis
G0248	Home INR monitoring
G3002	Chronic pain tx monthly b
G3003	Addition 15m pain mang
G9685	Acute nursing facility care
G0539	Initial care training 30 mi
G0540	train for caregiver add 15
G0541	no pt present train, initial 30
G0542	Care train to pts face to face 15 m
G0543	Group train w/o patient
G0560	Safety plan interven

Make treating injured workers easier, faster, and less costly. Chat with one of our experts to see how daisyBill can help your practice.

SCHEDULE CALL

0 Reader Comments

There are no comments for this article. Be the first to comment!

How did you like the article ?

DaisyBill provides content as an insightful service to its readers and clients. It does not offer legal advice and cannot guarantee the accuracy or suitability of its content for a particular purpose.