Wiki Telehealth Denials

[eizquierdo]

Hello,
We are Medicaid school based ffs, and have been getting the denial below. Claims for telehealth are submitted (ie: 99213 w/modifier 95). What am I doing wrong?
Denial CO-4: The procedure code is inconsistent with the modifier used or a required modifier is missing.

 

[TThivierge]

Hi Eizquierdo
There are telehealth CPT code to use too see CPT 99441-99442 phone for DO, MD NP and PA .Also the other staff like QA LPC LCSW or nurses can use series CPT 98966-98968. ensure document in record amount of minutes MDD and NOC complaint. Also using Eval. Mgt CPT 99202-99214 add MODIFIER 93 for phone .The MODIFIER 95 is for video .I hope this data helps you
Lady T

 

[jkyles]

Hello,
We are Medicaid school based ffs, and have been getting the denial below. Claims for telehealth are submitted (ie: 99213 w/modifier 95). What am I doing wrong?
Denial CO-4: The procedure code is inconsistent with the modifier used or a required modifier is missing.

Hi there, does Medicaid still require modifier 95? I know that Medicare dropped the modifier in 2024 and now requires a place of service - either 02 (if the patient was not at home during the encounter) or 10 (patient was at home). You should check to see whether Medicaid also switched to place of service.

https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets

 

[amyjph]

You have to check your plan/state being billed and check their telehealth policy for the date of service.