Wiki POS for online visit vs phone??

[pajohnson]

Hi All,
I have s situation where a patient is stating that her insurance(Anthem), has stated that there is a different place of service to use for her mental health therapy visits. I am currently using POS 02 for online (Zoom) therapy sessions. Is there another pos code to use for phone visits only? Any input is appreciated!!!

Thank you!

 

[csperoni]

Unfortunately, coding for telemedicine, whether audio/video or audio only, is like the wild west. CMS has guidelines. Some commercial carriers follow those guidelines. Some commercial carriers make up their own guidelines. You must follow whatever the guidance is of each particular carrier, and it can even differ for different plans with the same carrier. For example, Aetna Medicare and Aetna commercial may have different policies.
Google found me this for Anthem: https://providers.anthem.com/docs/gpp/WI_CAID_PU_COVID19GuidanceTelehealthBH_New.pdf?v=202106102103
If that does not answer your question, I suggest contacting the carrier directly.
Create a spreadsheet for yourself of each carrier and their guidelines. If possible, build those guidelines into whatever system you enter coding.
Good luck!

 

[OpenClaims]

Medicare just updated the guidelines for Telehealth appointments. If the patient is in their home, we are now advised to use POS 10. If you are unsure as to whether or not the patient was in POS 10 or 02 you can query. Also, are you using the correct modifiers? Anthem for Indiana requires a modifier 95 or GT on all Telehealth appointments. Anthem Indiana Provider News CMS Telehealth Place of Service Update

 

[shanamarie]

Medicare just updated the guidelines for Telehealth appointments. If the patient is in their home, we are now advised to use POS 10. If you are unsure as to whether or not the patient was in POS 10 or 02 you can query. Also, are you using the correct modifiers? Anthem for Indiana requires a modifier 95 or GT on all Telehealth appointments. Anthem Indiana Provider News CMS Telehealth Place of Service Update

Our local MAC which is NGS medicare advised that we are not to use the new POS 10 or 02 until the end of the PHE. If those are used then it will be a reduction in payment.

 

[OpenClaims]

Oh, well in that case, I'm unsure as I have been advised in my current role as a coder to use these updates.

Our local MAC which is NGS medicare advised that we are not to use the new POS 10 or 02 until the end of the PHE. If those are used then it will be a reduction in payment.

 

[ckeeney]

Also in Indiana, we have been billing POS 02 and 95 modifier for Anthem commercial claims for mental health services. So far no denials on that. I have been hunting around to see if there are any updated telehealth rules for Anthem commercial with both Medicare and Indiana Medicaid updating policies but haven't found anything updated.