Telemedicine billing, like most medical billing, varies across payers and by state, with differences in what telehealth services are covered, where virtual services can take place, and what details claims require. The information below intends to provide some guidance for small practices on typical practices and areas that might require special attention, but you will need to consult with your insurance plans and your state Medicaid agency to confirm the specific telemedicine billing policies applicable to your practice.
Note that for the duration of the COVID-19 public health emergency, most payers issued temporary guidance for telehealth coverage, with many requirements relaxed. Payers’ rules for reimbursement have been updated several times in a short period, and they likely will change again. Regularly check for changes to be sure your practice receives all the reimbursements due.
Documentation Is Key
You must have processes in place to ensure complete, accurate documentation necessary to support coding of services and billing. Key documentation for telemedicine billing includes the length of visit, technology used, and patient consent to use the technology.
Audit Your Denials
Continually audit your telemedicine claim denials to identify proper coding and clinical documentation required for both government and private payers. Addressing the reasons for denials quickly will lead to more compliant coding and increased reimbursements.
Claims: Place of Service Codes and Modifiers
Centers for Medicare & Medicaid Services (CMS) publishes a Place of Service (POS) code list for use on billing forms to indicate where the provider and patient were located during the encounter. Usually, you probably use code 11 for office. For synchronous telehealth services in Medicare and many other payers, POS 02 must go on the claim. Modifiers are two-digit codes added to CPT codes to provide additional information to payers. With Medicare, the modifier G0 identifies telehealth services furnished for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke. California Medicaid requires modifier 95 to indicate services were provided via interactive audio and telecommunication systems.
Telehealth for Medicare Patients
Medicare has specific rules regarding telehealth, such as geographic location and allowable diagnosis codes, and under normal circumstances restricts reimbursement for telemedicine billing. However, for at least the duration of the COVID-19 public health emergency, CMS has greatly expanded access to Medicare telehealth services, with all Medicare beneficiaries, whether new or established patients, now eligible. In addition to face-to-face telehealth visits conducted by video, practitioners also can provide virtual check-in services as well as provide certain services by telephone.
Use HRSA’s Medicare Telehealth Payment Eligibility Analyzer to learn whether a specific service is reimbursable by Medicare.
Use this information to get you started with providing telehealth visits to your patients on Carie’s virtual care platform.