Wiki TELEHEALTH BILLING

[metzger130]

I want to make sure I understand telehealth billing, especially since I see there is a 93 modifier now.

Medicare - Bill E/m with 95 modifier for all Audio/Visual calls
Medicare - Bill 9941-443 for Audio only with no modifier
Commercial insurance - Bill E/m with 95 modifier for Audio/Visual
Commercial Insurance - Bill E/m with 93 modifier for Audio only

Am I correct with these?

Thank you,
Rob

 

[Blackhorse]

We have not tried MOD 93 yet, but you are correct with the using of MOD 95 except UHC prefers to use MOD 2 for telehealth.

 

[csperoni]

At the beginning of the telehealth expansion during the PHE, many carriers basically said "We'll follow Medicare guidelines." However, many carriers came up with their own rules and guidelines, and have changed them over the past 2 years.
For commercial carriers, you must check their individual policy. Some won't accept -95 and want -GT. Some originally advised they will accept audio only with E/M 99211-99215. Some want POS 02. Some POS 11 (or whatever the POS would have been if not for the PHE). Unfortunately, there is no one single correct answer about how to properly code for commercial carriers.
I work for a large healthcare system and the corporate offices built in all sorts of rules behind the scenes so we can simply code it as telehealth. Then depending on the rules built, the system will automatically add -95 or -GT and POS.
My advice is to check the websites of your major carriers and create yourself a spreadsheet. If your EHR/billing system allows complex rules, I would advise to spend the time creating them.