Telehealth for Medicare
For Medicare telehealth charges, use the POS code for an in-person visit.
- For instance, you would use an 11 for what would have been an office visit.
- Medicare requires Modifier 95 in order for the provider to be reimbursed at the full Medicare rate, instead of the reduced rate typically paid for telehealth visits.
- Enter a modifier of 95 to the procedure line (such as M1 or M2). This modifier identifies that the charge is for a telehealth visit.
The following figure shows an example of a Medicare charge for a telehealth visit with POS 11 and Modifier 95.
Telehealth for Commercial Payers
- The telehealth Place of Service (POS) code is 02.
- The POS is pulled from the Service Facility and will need to be changed during charge entry for telehealth services.
- We do not typically recommend adding duplicate facilities to handle this (such as creating one facility twice for an office and telehealth).
- If all of your services are provided via telehealth during the COVID-19 crisis, you can temporarily change the POS on the Service Facility to 02.
- If you are providing both office and telehealth services, make sure you are being careful when completing a charge entry.
- Some payers require Modifier 95 to designate a telehealth charge, such as Medicare. For information on telehealth for Medicare see the following section.
- There is a Charge Management Rule to warn users who have entered telemedicine-specific, time-based CPT codes (99421-99423 and G2061-G2063) without a POS 02 code.
- For POS 02 reporting, use the Query by Form report or the Custom Encounter Query report. We are developing a POS filter and a Group By option available for many commonly used reports.
The following figure shows an example of the Post Charge panel for a commercial payer with a telehealth visit.
Resources
- CMS Place of Service Code Set
- CMS General Telehealth/Telehealth-Codes
- CMS Medicare Telemedicine Health Care Provider Fact Sheet
- CMS Medicare Telehealth Frequently Asked Questions
- AMA Telemed guide
- Billing Guide for Telehealth Encounters CCHP (see page 5 “Place of service”)