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Wiki What CPT Codes are used for Telehealth when POS would have been is 12 or 13
- Thread starter kdworrll
- Start date
During the emergency, it would seem telehealth or telephone encounters would be appropriate for this situation. For telehealth, the visit MUST be performed using and interactive audio and visual platform. HIPAA compliant is certainly preferred, but other services such as FaceTime and Skype are permitted temporarily.
If your provider is performing the visits with interactive audio/visual, you would bill 99201-99215 based on documentation or time, with POS 02. Medicare no modifiers. Most commercial carriers mod -95 unless instructed otherwise.
If your provider is performing TELEPHONE encounters only (must be established patient, must be initiated by patient, not related to visit in past 7 days or result in upcoming visit soonest available), then use G2012 for Medicare (or any other carrier who requests), or 99441-99443 for most commercial. POS 11.
If your provider is performing the visits with interactive audio/visual, you would bill 99201-99215 based on documentation or time, with POS 02. Medicare no modifiers. Most commercial carriers mod -95 unless instructed otherwise.
If your provider is performing TELEPHONE encounters only (must be established patient, must be initiated by patient, not related to visit in past 7 days or result in upcoming visit soonest available), then use G2012 for Medicare (or any other carrier who requests), or 99441-99443 for most commercial. POS 11.
Thank you Christine, just to clarify. the 99201-99215 are for the office. These patients are usually seen in there home or assisted living so we don't bill OV E/M, we will 99341-99350 or 99324 - 99337. Are the 992xx codes the only valid codes for telehealth?
Here is the Medicare fact sheet link. Those codes are not listed.
www.cms.gov
Right now, if a patient is in their home and the encounter is via interactive video and audio, then 99201-99215 with POS 02 are appropriate.
I think the home/assisted living visits are valued slightly higher to account for the provider's time to get to the location. Since the provider is not traveling, they can see more patients in the same time or the same number of patients in less time.
MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET | CMS
Medicare coverage and payment of virtual services INTRODUCTION:
Right now, if a patient is in their home and the encounter is via interactive video and audio, then 99201-99215 with POS 02 are appropriate.
I think the home/assisted living visits are valued slightly higher to account for the provider's time to get to the location. Since the provider is not traveling, they can see more patients in the same time or the same number of patients in less time.
UPDATE ON 04/02/2020 TO ORIGINAL POST, AS GUIDANCE FROM CMS HAS CHANGED
As of 03/31/2020, 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.
As of 03/31/2020, 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.