Wiki Telephone Encounters - Modifers, POS, fee schedule

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brepola

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I know we are all on in this together but the more and more I dig in the more confused I get. We are trying to get a handle on these telephone encounters and our office JUST got the OK to start running antibody testing as well and there are new codes for that. 86328 86769 the AMA recommends to check with your local insurance companies Any help on any of the following issues would be greatly appreciated.

When this first started I was told to bill an EM with a POS of 02 with E/M 99211-99215 with a GT modifier. Now I am learning that seems to be more for a hospital setting than an outpatient provider office (we are internal medicine office setting).

I found this from CMS from 5 days ago saying to use (attached)

CS modifier - use the EM but it also mentions for telehealth you can add 99411-99443 in addition to your EM Has anyone done this successfully? if so what modifier did you use.

Also super confused about the POS - when this started I was told to use POS: 02 - telehealth (and it worked but the reimbursement was not sufficient) now they are saying to use your regular place of service (in our case: 11).


HELP!!!!!
 

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  • CMS telehealth CS WPS Modifier.pdf
    212.3 KB · Views: 17
1) Telehealth (video and audio) CMS current guidance is to bill E/M with POS 11, modifier -95. The original guidance was POS 02 and no modifier, but since that pays at facility rate, and the practice is still incurring an expense, they revised to POS whatever you would typically bill, modifier -95. Private carrier policies may differ.
2) Modifier -CS is for a service that results in an order for or administration of a COVID19 test.
3) 99441-99443 are for audio only encounters (not telehealth). Historically, they were noncovered by Medicare, but are now covered during the emergency. They may not be billed if related E/M service in past 7 days, nor leads to upcoming appointment/procedure (within 24 hours or soonest available). POS 11, no modifier since it is not telehealth. Again, private carrier policies may differ.

If the reference you attached is too confusing, maybe this is clearer: https://www.ngsmedicare.com/ngs/por...exlzYZPhM8QvQCugf/dz/d5/L2dBISEvZ0FBIS9nQSEh/
 
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