Medicare Final Rule Telehealth

[wfisher67]

I have 2 questions:

Will this apply to Medicare Advantage as well?
Is it possible to bill a Telehealth as a 99214 but use POS 11? (my doctor is asking) I said NO, but he wants me to ask the question anyway. My physician is a Concierge doctor and we have patients in different states.

 

[TThivierge]

Wfisher
If providers documents CPT 99214 can add the modifier 95 video and 93 phone call. Or use CPT 99441-99443 for phone only ensure pt minutes in documentation and tell if phone or video
Hope this data helps
Lady T

 

[wfisher67]

Wfisher
If providers documents CPT 99214 can add the modifier 95 video and 93 phone call. Or use CPT 99441-99443 for phone only ensure pt minutes in documentation and tell if phone or video
Hope this data helps
Lady T

Per the Final Rule you can not bill 99441-99443 for 2025. We are not in a rural area, so I don't think 99214 95 modifier will work. CMS is going back to Pre-pandemic geographic and location, unless I am reading this wrong.

 

[JDACPC]

If you watch the news and the government shut down hullabaloo, the telehealth flexibilities are/were maintained in that bill. As it stands right now, on this morning of 12/20/24, Congress has struck down two bills that would have extended telehealth flexibilities, so we are back to square one with what the final rule states which is telehealth is over unless you are in a shortage area or for Beh Health services. The first bill extended the current rules for two years, the second bill only extended for 90 days, but again, both are stuck down at this moment.

*IF* they can come to an agreement on the telehealth, then yes, we can bill office visits for the telehealth visits with the modifiers. However, CPT created new telehealth codes but CMS will not be paying for them, we are to use the OV codes + mod. Med Advantage plans are to follow CMS rules but commercial plans do not. In my organization, we have the new codes set up and ready to go, if approved, so that Medicare, and those insurances we know follow MC, will be billed with OV+mod, all other insurances will be billed with the new telehealth codes. The audio-only codes 99441-99443 have been deleted no matter what happens with telehealth.

 

[JDACPC]

UPDATE: Congress approved a short extension on telehealth through March 31st, 2025. Here is the link, Section 3207, EXTENSION OF CERTAIN TELEHEALTH FLEXIBILITIES, starts on page 102

https://docs.house.gov/billsthisweek/20241216/ARA 12.20.pdf