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TELEHEALTH SERVICES
RichardP:
See Point 4 of what I posted upthread.
Only facilities are to use modifiers. Private practice does not. Except in three cases, which will not apply to most posting here.
See Point 18 here:
https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
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I think I answered the wrong question - but its a question that is bound to come up, so I am going to leave that response there.
Here is the correct answer:
Note the distinction made at Point 5 above. Quick phone calls initiated by the patient should be coded with the G2012 (voice) or G2010 (digital image transmission) codes. These are called Virtual Check-Ins.
Telehealth is when a patient calls and makes an appointment. In this case, the doctor initiates the phone call to the patient at the appointed time. This call is supposed to be via a device that supports audio and visual (smart phone; tablet; laptop, etc). These would be the instances where the office visit codes are used (new or old patients), as well as the few other codes listed at the link I gave at Point 6 above.
CMS makes it clear that there will be little to no auditing during this period, and they have relaxed the HIPPA requirements - so unofficially I think it is safe for the doctor to use a land-line for those patients who are not computer-savvy and who only have a land-line.
As CMS makes clear in their communications, the objective is to get health-care to the elderly who need it - without forcing them to put themselves at risk by traveling to wherever their provider is located. So understand that CMS will accept whatever is requried to get the health care to these older folks. Unofficially I'm saying use the land-line if that is all the patient has. That is within the spirit of what CMS is trying to do.
Finally - you must use POS 02 for these telehealth calls. Everything else should be coded as though the patient actually came into the office - with the caveat that you should not be coding for drawing blood, etc on a telehealth Claim Form.
Michele:
We are being bombarded with memos, etc from all insurance carriers and it's so hard to sort it all out, while handling the phone calls, employee restrictions, etc. This is a great resource. Thanks again Richard.
NYS just issued an order yesterday declaring medical billing businesses as "essential". But we still have to be careful since we are at risk. Thankfully we have space here to separate people, but not all MBBs do.
Stay safe and healthy everyone!
RichardP:
We have received notice from United Health. They seem to be following what CMS is doing. But it appears that, in addition to POS = 02, they want Modifies. Hopefully I can pay more attention to what they sent over the weekend and put a brief summary together.
I placed the PDF file into Dropbox. Let's see if I can create a link to that now. Feel free to distribute to whoever might benefit from this information.
https://www.dropbox.com/preview/Misc/TeleHealth%20during%20Covid-19.pdf?role=personal
RichardP:
Why am I not surprised. CMS changes the rules in the middle of the game.
Use POS = place where service would normally have been received. (office visit = 11 for us).
Use modifier 95.
https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-03-mlnc-se#_Toc36815181
For the commercial carriers we use, Blue Shield of California and Cigna require no modifier. All else want GT or 95. Given this is a state by state thing, your mileage may vary.
patnadluke124:
Has anyone billed Tricare East (Humana Military) for telehealth services yet? I am a little confused with their guidelines. It states to bill your cpt codes and add modifier 95 with place of service code 02. I understand that part, then it goes on to say use code Q3014 for originating site. That is where I get confused.
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