Correct TelelHealth Place of Service Code

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So, my company is a Telehealth company for Participants Of Mental Behavioral Health Services, in which we provides services Via Phone and/or Video Face to Face. I'm having a issue with one payer, in which we are contracted with, that sometimes pay use correctly and then at times they won't. The problem, is the place of service code we use. My company has Host of Therapists around the world that are under our Tax id and NPI. And are contracted under us for these services.

Example:
you may live in New York (participant) and you chose to do your sessions Via Video, your Therapist lives in Texas. The Therapist is from our company. Once your session is done we submit the claim, the claim comes back rejected because the Rendering provider lives in Tx and the services were done in NY. Yet we have a full cost sharing Contract.

Can you Help me in finding a Correct Place of Service Code to use and how to go to start the process, it would be much Appreciated.

Thank you,
AAPC Member
 
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Coverage for telemedicine is determined by state-specific laws and regulations. What may be allowed in one state may not be in another. Although you have a contract with a specific payer, they are bound by these laws. Additionally, the payer may have their own guidelines and restrictions. The location of the patient is where the care is being delivered and therefore the state in which the patient resides has jurisdiction over the telemedicine encounter.

These laws and regulations include things like:
- What originating sites are eligible (eg, a patient's home)
- What distant sites are eligible
- What type of provider can perform a specific service
- What types of services are eligible
- What licenses a provider is required to have (some states require the provider be licensed in that state, where the patient resides)
- What forms of telemedicine are eligible (eg, video, telephone, email)
- What additional requirements must be met (eg, a patient has to have one face-to-face encounter with the provider before the telehealth services can begin)
etc....

New York does identify a patient's home as an eligible location if the residence is located within the state. The law also states that the distant site provider must be authorized to practice medicine in within the State of New York. In your example, if the provider in Texas is not authorized by New York State to perform the service, then the service can't be paid for. Performing the service in, and of itself, is considered illegal in New York. Although you have a contract with the payer, State (and Federal) laws will always be the controlling factor.

Also, you mentioned that you have providers overseas. I have never read one piece of legislation for any state that would permit telemedicine being performed by anyone who is not located in the United States. These laws change all the time, but I would bet, hands down, there will never be a law passed that would allow for this.
 
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