Just when you thought you got your head semi-wrapped around Medicare telemedicine rules, they go and throw it out the window! On March 30, CMS issued an Interim Final Rule and released new guidance on how to code and bill for rapidly evolving telehealth services.

Before you file another claim, here are the three sweeping changes you must implement now. Taking the time to apply these new telehealth billing rules now means you’ll receive claims payment faster – and face fewer denied claims in the future.  

Apply Telehealth Modifier 95 to All Claims

There has been a lot of confusion over what modifier to use when submitting claims for telehealth services with an E/M code such as 99201-99215 (Office visits). The March 31, 2020 COVID-19 National Stakeholder Call provided one uniform method.

Now you’ll use modifier 95 on ALL Medicare telehealth claims – professional and facility, clarified CMS Administrator Seema Verma. Modifier 95 indicates the office visit was performed via telehealth – and gets the claim to process around Medicare’s historic system edits.  

Eliminate Telehealth Claim Denial Trigger With Usual Place of Service

If you’ve been confronted with a wave of telehealth denials, the new CMS Place of Service guidelines should hopefully eliminate this frustration.

Effective immediately, you should no longer apply a Place of Service (POS) of 02 to indicate telehealth. Instead, you should use the intended originating site of where you would have provided the service outside of COVID-19.

Example: If you would have seen the patient in the office with place of service (POS 11), then that’s the POS you report now.

Modifier 95 with POS 11 indicates the office visit was performed via telehealth. It also allows the service to be paid at 100%. Using a POS of 02 subjects the code to a facility reduction of 15%.  

Digital Visits Now Allowed for New Patients Too

The new telehealth rule changes also change which patients you can bill for virtual check-ins. Codes G2010 and G2012 (digital communication services) were previously restricted to established patients only. They now are applicable to new patients, too.  

Stay Up to Date

HPCA is tracking changes to telehealth and other COVID-19 topics. Updates will be posted on the recently launched COVID-19 Action Center website.

The COVID-19 Action Center hosts a variety of how-to articles, tools and online training sessions to help you ethically optimize the reimbursement you receive during these challenging times.

The next related training “Coronavirus: Get Paid for Private Pay Non-Face-to-Face Patient Care” is being presented by coding expert, Kim Garner Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, on April 8th, and will be covering private payer telemedicine reimbursement

Take Advantage of Our Best-selling Telehealth Resources