Question TELEMEDICINE CODING

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Please help - I was to understand that with medicare you use pos code 2 for telehealth services and no modifier and for commercial claims we are to use modifier 95 or GT, is this correct?
 

kstine713

Networker
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arosborne

New
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Lakeland, FL
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Place of service code 02 for all payers for telemedicine with audio and video (not telephone), modifier 95 (synchronized audio and video use) for commercial payers, modifier GT for Medicare, and the provider's regular E&M. If it is a telephone visit only, refer to the CPT section for 99441-99443 of the CPT book. That section also has other guidelines specifically related to telephone only visits.
 

csperoni

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Selden
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Yes, there was a change as of 03/31/2020. Basically, originally for telehealth, you were paid the facility rate with POS 02. CMS has decided that since the offices are still typically having their support staff, etc., you may bill POS 11 (or whatever POS you would typically bill for visits) with modifier -95 to designate as telehealth. Medicare will then pay the full nonfacility rate.
This is CMS guidance, and commercial carriers will vary. Rely on the guidance of each carrier for their rules.
 

csperoni

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As of 03/31/2020 interim final rule, CMS states for telehealth, "report the POS code that would have been reported had the service been furnished in person." with modifier -95 to designate it was telehealth. This way, you will get full reimbursement for nonfacility location, instead of reduced facility rate with POS 02.
Medicare will also now reimburse 99441-99443.

Guidance about POS/modifiers page 14-15. Guidance about 99441-99443 starts at bottom of 126.
This is CMS guidance only, and you should check with your commercial carriers about their rules.
Interim final rule: https://www.federalregister.gov/documents/2020/04/06/2020-06990/medicare-and-medicaid-programs-policy-and-regulatory-revisions-in-response-to-the-covid-19-public
 

michiboo

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By any chance do any of you know if a provider using video and has difficulties and converts to telephone, I heard they are to still bill it as video and or should be using telephone 99441-43 instead and document time. So a bit confused in what to do in this scenario.
 

csperoni

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I had not seen official guidance on this scenario. My personal opinion would be if the majority of the visit took place via video, to use telehealth codes. If it failed right away or at the beginning, use telephone encounter.
Either way, I would also document the situation that you started via video and had to convert to telephone.
 

michiboo

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Thank you, I agree with everything you said, it makes it hard when you come to these situations and just trying to keep up with all the changes :)
 

michiboo

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Sorry one more question, do any of you know if
Providers can bill for virtual visits with patients from their homes? is there a source somewhere I can read or follow?
 
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