Telehealth services for 90966 code

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Omaha, NE
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Good afternoon

My physician is doing some Telehealth Services on PD and Home Dialysis patients, to my understanding we can bill for these services, but I can not seem to find how to bill, do we use the 90966 code as usual or do we add a mod 95 to the 90966 - I have looked and can not find an answer to this.

Let me know if anyone has billed this telehealth services or can tell me the correct way
Thank you
Caroline
 
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Hello,
Assuming the visit meets the rest of the definition of a telehealth service, you would not report 90966 with 95. Here is the full descriptor for 95, emphasis added:

Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System: Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified healthcare professional and a patient who is located at a distant site from the physician or other qualified healthcare professional. The totality of the communication of information exchanged between the physician or other qualified healthcare professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via face-to-face interaction. Modifier 95 may only be appended to the services listed in Appendix P. Appendix P is the list of CPT codes for services that are typically performed face-to-face but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
90966 is not included in Appendix P.
 

mitchellde

True Blue
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Columbia, MO
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I do not believe that 90966 qualifies for telehealth services. also if you do some research you will see that we do not use the GT or GQ modifier with only a few special exceptions, Medicare will key off the POS code for telehealth and the commercial payers use the 95 modifier plus the telehealht POS. however the service provided must be approved for telehealth. Also the patient must meet the requirements for telehealth services. I would contact the payer to see if you have met all the requirements and determine if the service you are providing meets the approval.
 
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