Risk adjustment treatment of telehealth and telephone services
Guidance on which telehealth, e-visit, and telephone-only service codes are valid for submission to the HHS-operated risk adjustment program for the 2020 and 2021 benefit years; applies to issuers submitting data to EDGE servers and to providers whose services are submitted, subject to applicable state law.
HHS extended designation of certain telehealth, e-visit, and telephone-only CPT codes as valid for 2021 benefit year risk adjustment data submissions, subject to state law.
Telehealth and telephone-only services are considered equivalent to face-to-face services for inclusion in risk adjustment filtering, provided provider type, diagnostic value, and state law requirements are met.
HCPCS codes G2061-G2063 are no longer valid for 2021 benefit year risk adjustment data submissions because they were terminated effective December 31, 2020.
Risk Adjustment Submission Criteria
Risk adjustment submission criteria for telehealth and telephone services
Conditions under which telehealth and telephone service diagnoses are valid for submission to the HHS-operated risk adjustment program:
Designated codes valid for 2020 and 2021 benefit years
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