Telehealth Billing

Telehealth Billing

Telehealth for Medicare

For Medicare telehealth charges, use the POS code for an in-person visit.
  1. For instance, you would use an 11 for what would have been an office visit.
  2. 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.
    1. 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

  1. The telehealth Place of Service (POS) code is 02.
    1. The POS is pulled from the Service Facility and will need to be changed during charge entry for telehealth services.
  2. We do not typically recommend adding duplicate facilities to handle this (such as creating one facility twice for an office and telehealth).
    1. 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.
    2. If you are providing both office and telehealth services, make sure you are being careful when completing a charge entry.
  3. Some payers require Modifier 95 to designate a telehealth charge, such as Medicare. For information on telehealth for Medicare see the following section.
  4. 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.
  5. 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

  1. CMS Place of Service Code Set
  2. CMS General Telehealth/Telehealth-Codes  
  3. CMS Medicare Telemedicine Health Care Provider Fact Sheet
  4. CMS Medicare Telehealth Frequently Asked Questions
  5. AMA Telemed guide
  6. Billing Guide for Telehealth Encounters CCHP   (see page 5 “Place of service”)

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