Wiki Senior Behavioral Telehealth

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klightner

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I am hoping for some help here. I just took over the coding for our inpatient senior behavioral health unit that is all done via telehealth, even prior to COVID-19. I am receiving many, many denials stating the CPT and place of service are not compatible. I am billing 99231-99233 with modifier GT and place of service 02. I have also tried removing the GT modifier and billing just the CPT code with place of service 02. I did verify that 99231-99233 are eligible to be billed in place of service 02 so I am at a loss with these denial. Any help will be greatly appreciated!
 
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Since you are mentioning the GT modifier, it sounds like you are billing for the facility, which does not bill the hospital visit code.

If you are indeed billing for the hosting facility and not the performing provider, the POS should be 21, 51, whatever the unit is identified by, unless the payer requires 02. My notes say for Medicare, you use the regular POS code and not the 02. And you would not bill the hospital visit code (99231-99233), because the facility isn't doing the visit. The code you want is Q3014, which is the code for the originating site facility fee.

If you are billing for the performing provider, you would bill the 99231-99233, with pos 02, and the 95 modifier (unless your payer specifically tells you to use GT).

Generally (not during the crisis as the rules are different for that), 99231-99233 is allowed to be by telemedicine only 1 visit every 3 days.
 
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medicare denied my claims for telemedicine claims, pt is in assisted living facility and we did telemedicine. so I billed pos 02 cpt code 99336 and modifier 95. Denied due to place of service. What is the right billing. Please advise. need help.
 
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Our MAC (WPS) issued the following: "When billing professional claims for all telehealth services with dates of service on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with
* Place of Service (POS) equal to what it would have been had the service been furnished in-person
* Modifier 95, indicating that the service rendered was actually performed via telehealth"

99336 was temporarily added to the list of telehealth services.

I would check with your MAC.
 
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