Wiki GHI Telehealth Billing Guide

[swetap]

We are billing 99213 (95) since 2020 but recently GHI of NY is denying for the reason that Telehealth Place of Service code is not valid. Please guide on this if you guys have any latest update on this.

I know all other insurances are paying for televisit code 99213 if we bill in POS 11 with 95 modifier AND POS 02 without modifier.

Thanks in advance!

 

[sls314]

We are billing 99213 (95) since 2020 but recently GHI of NY is denying for the reason that Telehealth Place of Service code is not valid. Please guide on this if you guys have any latest update on this.

I know all other insurances are paying for televisit code 99213 if we bill in POS 11 with 95 modifier AND POS 02 without modifier.

Thanks in advance!

I looked up GHI of NY, and it took me to an EmblemHealth website. (Perhaps the administrator of that plan?)

On the EmblemHealth website, I see they may have had a change to the telehealth reimbursement policy in 2022, and they may want POS 2 or POS 10 for telehealth services.

You'll want to confirm exact specifics with the payer, of course. Either by phone call, or looking for the policy in your provider portal.

 

[swetap]

Thank you so much for the guidance. I wil follow up with the payer - EmblemHealth.