Wiki Medicaid Telemed via Telephone

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oskolkoff

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Has anyone found a code that Medicaid pays for Telemed visits via telephone? We are an Tribal Clinic with MDs, DOs, and NPs. We have received denials for the new CPT codes 98008-98015 and the use of EM codes with a 93 modifier. Telemed visit via audio visual codes are paying with the EM and modifier 95.

Thanks for the help
 
Hi there, you'll need to check the payer's policy. The payers are all over the place with telehealth.
 
oskolkoff said:
Has anyone found a code that Medicaid pays for Telemed visits via telephone? We are an Tribal Clinic with MDs, DOs, and NPs. We have received denials for the new CPT codes 98008-98015 and the use of EM codes with a 93 modifier. Telemed visit via audio visual codes are paying with the EM and modifier 95.

Thanks for the help
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2025 has new rules and regulations per the CMS guidelines. Medicare is, as far as I know, the only one paying for telehealth. Private insurance is denying. There are new codes this year for telehealth. Please look up the LCD for your area. I am an RCM company, and my contract is in Florida. What I did was google the LCD for telehealth CMS guidelines for Florida, and I was able to find the most updated version of the CMS policy for the new telehealth guidelines. Then what I did was I uploaded the LCD into ChatGPT and asked ChatGPT to make me a provider checklist for the key requirements for telehealth per the CMS guidelines. Please see attached; this is what ChatGPT produced for me. I LOVE CHATGPT (I do have a paid plan); it saves me so much time and headache. I distributed this checklist to my providers and told them to use it as a guideline for their progress notes and claims. If any of the key requirements were missing from their progress notes, the claim would be returned to them for an addendum.
 

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