Does G2251 require prior authorization?

No, G2251 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G2251?

Medicare facility rate: $10.69. Non-facility rate: $14.03. Work RVU: 0.25.

Verity

`G2251` — Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.25

Facility

$10.69

Non-Facility

$14.03

Documentation Required

The medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.
Medical record must include relevant medical history, applicable comorbidities/medications, prior diagnostic imaging/testing results, prior therapy history for the same diagnosis, and results of pertinent tests/procedures.

All services ordered or rendered must be signed and dated; a legible identifier (handwritten or electronic signature) of the person(s) who provided the service is required.

Documentation must be legible, relevant, sufficient to justify medical necessity, and should paint a clear picture of impairments, functional limitations, prior functional level, and the skilled nature of treatment provided.

Documentation must clearly record both Timed Code Treatment Minutes and Total Treatment Time to justify the number of units billed.

The record must identify each specific skilled intervention/modality provided and include outcome measures or other assessment tools to demonstrate clinical progress.

Key Coverage Criteria

Therapy services are covered when the medical record and claim consistently and accurately document that the services are covered and medically necessary.
Therapy is covered when the patient has impairments and functional limitations that require the unique skills of a clinician (therapist) to improve functioning.
Coverage requires an initial evaluation performed by a clinician that documents objective findings, baseline functional testing using standardized scales, realistic goals, and expected rehabilitation potential.
Services are covered when documentation provides objective measurements or assessment results that demonstrate clinical progress toward the patient's identified functional limitations.
Therapy is covered when documentation justifies the type, frequency, and duration of skilled therapy as medically necessary for the individual patient's condition.
Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.

4 Active Policies

A57067 — Billing and Coding: Outpatient Physical and Occupational Therapy Services

A57311 — Billing and Coding: Physical Therapy - Home Health

L34049 — Outpatient Physical and Occupational Therapy Services

L33942 — Physical Therapy - Home Health

Have a follow-up question?

Ask Verity about documentation requirements, denial risks, or coverage in your state.