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Telehealth

  1. Default Telehealth
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    Can Telehealth services for Substance Abuse be billed on a UB-04 Form? Or does it have to be on a CMS-1500 form? Also, do we bill where the therapist is or where the patient is?

  2. #2
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    Two good links: 1st one: https://www.cms.gov/Outreach-and-Edu...ads/SE1604.pdf



    And then this one:



    "The CMS-1500 form is the health insurance claim form used for submitting physician and professional claims for providers.

    When a physician has a private practice but performs services at an institutional facility such as a hospital or outpatient facility, the CMS-1500 form would be used to bill for their services.

    The CMS-1450 (UB-04) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services. Durable Medical Equipment (DME) would typically be submitted using the CMS-1500.

    The CMS-1500 is used to submit charges covered under Medicare Part B. The UB-04 or CMS-1450 to submit charges under Medicare Part A."


    https://www.all-things-medical-billi...r-cms1450.html


    Hope one of these helps...

  3. #3
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    Here is the CMS guide to billing telehealth services which I think is a pretty comprehensive reference:

    https://www.cms.gov/Outreach-and-Edu...-Text-Only.pdf

    As you'll see, there are two providers involved with any telehealth service - the 'originating site' and the 'distant site practitioner'. The distant site practitioners only provide professional services, so these charges would always be submitted on a 1500 form. The originating site may be a facility, so the facility will bill the fee (Q3014) for their part of the telehealth, in addition to all of the other facility fees that are associated with that service and the patient's stay, on the UB-04 claim.
    Thomas Field, CPC, CEMC

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