Use of telehealth and e-visit codes for HHS-operated risk adjustment data submissions (COVID-19 guidance)
Clarifies which telehealth, telemedicine, and new e-visit codes are valid sources of diagnoses for data submissions to issuers' EDGE servers for the HHS-operated risk adjustment program for the 2020 benefit year; applies nationally (HHS-operated program for all states and DC) and is subject to applicable state law.
Designates six new e-visit codes (CPT 99421-99423 and HCPCS G2061-G2063), effective January 1, 2020, as valid for 2020 benefit year HHS-operated risk adjustment data submissions.
Telehealth visits are considered equivalent to face-to-face interactions for purposes of inclusion in risk adjustment filtering, provided provider type and diagnostic value requirements are met and state law allows.
Policy Snapshot
This guidance clarifies which telehealth, telemedicine, and newly designated e-visit codes are valid sources of diagnoses for data submissions to issuers' EDGE servers for the HHS-operated risk adjustment program for the 2020 benefit year. It applies nationally to the HHS-operated program for all states and the District of Columbia. The policy is CURRENT with an effective date of April 27, 2020.
For the 2020 benefit year, HHS is designating six e-visit codes—CPT 99421-99423 and HCPCS G2061-G2063—effective January 1, 2020, as valid sources for diagnosis filtering in risk adjustment data submissions, subject to applicable state law and the programs filtering rules.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.