We support and encourage you to provide care for new and established patients through 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.
Payment for services is based on the lesser of the Colorado Department of Workers Compensation (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 only audio is utilized, then services are not considered telehealth. If telehealth (audio and video) is utilized, refer to some of the codes listed below.
Teleheath E&M services (video and audio)
Add the modifier -95 to the E&M code and use place of service (location code) 02 or 10
99202 - 99215 Office or other outpatient visit
99241 - 99245 Consultations
Teleheath Psychological services (video and audio)
Add the modifier -95 to the code and use place of service (location code) 02 or 10
90832 – 90838 Individual psychotherapy
90791 – 90792 Psychiatric diagnostic interview examination
96116 Neurobehavioral status examination
Teleheath E&M services (video and audio)
Add the modifier -95 to the code and use place of service (location code) 02 or 10
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 code and use place of service (location code) 02 or 10
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.)
97129-97130 Therapeutic interventions that focus on cognitive function
97150 Group therapeutic procedure
97542 Wheelchair management
97750 Physical performance test or measurement
97755 Assistive technology assessment
97760 & 97763 Orthotic/prosthetic management and training
97762 Prosthetic training, initial
For billing and coding assistance, contact billingsuccess@pinnacol.com or 303.361.4940.