Author Topic: Medicare telehealth  (Read 271 times)

mlr5005

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Medicare telehealth
« on: December 21, 2021, 03:11:13 PM »
I am wondering if anyone has solid info on the POS/modifier details needed for Medicare claims. I work for an outpatient psychotherapy practice. I am speaking in reference to CPT codes that I've verified are telehealth-eligible even after the current public health emergency ends (ex: 90837, 90834...)

Prior to the pandemic I believe the coding was POS 02, no modifier needed.

Then very early during the pandemic I was instructed (by who I cannot recall, maybe my claims software provider?) that we should be using POS 11 with modifier 95, as Medicare was trying to track the covid-related sessions that would have been held in-person if not for the pandemic. I've been rolling with that ever since.

Now I have caught wind of new POS 10 to take effect April 2022 which indicates telehealth from a client's home (vs 02 which indicates telehealth from another place, like a nursing home). There are also apparently changes to POS 02 that have stipulations around in-person visits occurring prior to being seen via telehealth ***topic for another day but please chime in if you know about this too, as I've seen conflicting information about whether or not that requirement can be "waived"?

Anyway: Has anyone heard of this? Does this only apply to Medicare and not other insurances? What is the correct way to code outpatient psychotherapy via telehealth for a Medicare client? And also I saw a line in a document emailed to me that says, and I quote, "Medicare hasnít identified a need for new POS code 10", so what is happening?! :) Any/all comments welcome!

Michele

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Re: Medicare telehealth
« Reply #1 on: December 21, 2021, 04:13:52 PM »
From our understanding currently with Medicare:

Telehealth should be billed with a POS of 11 and a 95 modifier, no other requirements.


Effective 4/4/2022, telehealth in the patient's home with a POS of 10,  telehealth in other originating sites with a POS of 02.   The 02 may require that  the patient was previously  seen in person prior to the telehealth visit.

That's the information we have at this time.  We are going to be putting out a newsletter soon with information on this topic.  If you are not signed up you may want to get the newsletter.

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Re: Medicare telehealth
« Reply #1 on: December 21, 2021, 04:13:52 PM »