Noridian Medicare Telehealth

[sandra_hamiltonclark@watsonvillehospital.com]

Is modifier 95 still necessary in 2024 for either In-Patient or Out-Patient telehealth services for Noridian?

 

[csperoni]

I don't work for providers that fall under Noridian, but my MAC (NGS) has stated CMS indicates -95 is applicable ONLY if provider is in a hospital and patient is at home.

https://www.ngsmedicare.com/web/ngs/news-article-details?selectedArticleId=10638446&lob=96664&state=97133&rgion=93623

"CMS indicated in the 2024 Physician Fee Schedule Final Rule that billing with the modifier 95 would be allowed to continue when “the clinician is in the hospital and the patient is in the home, as well as for outpatient therapy services furnished via telehealth by PT, OT, or SLP.” These are the only scenarios where the usage of modifier 95 would be appropriate for billing fee-for-service Medicare. Any other telehealth service is billed with POS 02 or 10 dependent upon where the patient is located when the service is provided."

 

[sandra_hamiltonclark@watsonvillehospital.com]

Thank you, that's the way I interpret it too.