Update on place of service and modifiers for telehealth…

As the COVID-19 Pandemic continues, providers and billers look for updates on coding for telehealth services.  Prior to COVID-19 the average biller didn’t have to know anything about telehealth billing but post COVID-19 almost all billers have had to learn.  So where are we almost eighteen months later?  Basically in the same position. Each insurance carrier has their own guidelines for billing telehealth services.  Most of the restrictions have been lifted allowing almost all providers to provide telehealth services.  The insurance carriers were scrambling to set up guidelines for billing and they didn’t all set up the same.  Here are some of the ones we know:

Medicare requires that telehealth services be billed with a place of service code of 11 and a 95 modifier.

TRICARE requires that telehealth services be billed with a place of service code of 02 and a 95 modifier.

CIGNA  requires that telehealth services be billed with a place of service code of 11 and a 95 modifier.

MVP  requires that telehealth services be billed with a place of service code of 11 and a 95 modifier.

Aetna requires that telehealth services be billed with a place of service code of 02 and a 95 modifier.

Health First requires that telehealth services be billed with a place of service code of 02 and a 95 modifier.

Emplem requires that telehealth services be billed with a place of service code of 11 and a 95 or a GT modifier.

Most BCBS plans requires that telehealth services be billed with a place of service code of 02 and a 95 modifier.

There is no way to list them all.  Bottom line it is important to figure out how the carrier that is being billed requires it to be submitted and follow those rules.  If a claim is denied, check with the carrier to see what their requirements for telehealth services are and refile the claim.

2 Responses to “Update on place of service and modifiers for telehealth…”

  1. Barbara Griswold, LMFT Says:

    Hi guys!

    My comments below, in red

    >

    • SolutionsMedicalBilling Says:

      Thanks Barbara!

      Barbara provided information that indicates that CIGNA requires that the place of service be 02, not 11. This contradicts our previous information and upon further checking they actually contradict themselves. So the best thing I can say is to bill it the way you believe best describes what was done, and if it denies you may have to change it. Here’s what Barbara has:

      Billing guidance

      Behavioral providers who meet telehealth requirements (see above) may deliver services via telehealth with no additional credentialing.

      Individual providers and outpatient clinics

      If you are an individual provider or an outpatient clinic, you may use telehealth for outpatient therapy, applied behavior analysis (ABA),* medication management, and Employee Assistance Program (EAP) services. Include the following information on your claim form:

      o Appropriate Current Procedural Terminology (CPT®) code in Field 24-D for the service(s) provided

      o Modifier 95** in Field 24-D to specify telehealth (see sample claim form below)

      o Place of Service (POS) 02 in Field 24-B (see sample claim form below)

      I’ve been billing all along for CIGNA clients with the 02 and it is getting paid just fine. I see online in two places that CIGNA wants POS Code 11 and in other places POS Code 11 in various places, but this is when they are referring to a an E&M service. Confusion!


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