Medicare Telehealth Basics

Medicare removed many restrictions to bill telehealth claims in the wake of this COVID pandemic. But we should always remember that current telehealth billing guidelines would take a different shape once this pandemic is over and we should aware of the basics of Medicare guidelines for billing telehealth services.

From here consider there is no pandemic happened and you are providing telehealth services and billing to Medicare as per regular guidelines. I will make this short and if anyone needs more info can follow links provided at the end of this writing or can send me your queries.

So now we will see criteria’s need to be fulfilled to be eligible for billing telehealth services…

• Qualified originating site (Site from where a patient should receive care via real time audio-video interface)

• Eligible healthcare professional (Type of credentialed providers can provide service from a distance site)

• Services or care eligible to provide through telehealth.

Originating site

There are two type of geographical parameters for originating site.

1. Location

• A county outside a Metropolitan Statistical Area (MSA

• A rural Health Professional Shortage Area (HPSA)

2. Type of healthcare facilities (Below facilities should be within above geographical location with few exceptions formatted in bold letters)

• Physician offices

• Hospitals

• Rural health clinics

• Critical Access Hospitals(CAHs)

• Federally Qualified Health Centers(FQHCs)

• Skilled Nursing Facilities (SNFs)

• Renal Dialysis Facilities

• Hospital-based or CAH-based Renal Dialysis Centers (including satellites)

• Homes of beneficiaries with ESRD getting home dialysis

• Community Mental Health Centers (CMHCs)

• Mobile Stroke Units

Note: Independent Renal Dialysis Facilities are not eligible originating sites.

Type of Healthcare professional

1. Physicians

2. Nurse practitioners (NPs)

3. Physician assistant s (PAs)

4. Nurse-midwives

5. Clinical nurse specialists (CNSs)

6. Certified registered nurse anaesthetists

7. Clinical psychologists (CPs) and clinical social workers (CSWs)

8. Registered dietitians or nutrition professional

Note: A physician, NP, PA, or CNS must furnish at least one ESRD-related “hands on visit” (not telehealth) each month to examine the beneficiary’s vascular access site.

Allowed services through telehealth

Services should be provided through real time audio video communication with exception to Alaska and Hawaii where medical file can be recorded and transmitted to eligible healthcare provider. Visit below links for the list of CPT codes allowed for telehealth services.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/telehealthsrvcsfctsht.pdf

From the billing prospective you need to bill these services with appropriate place of service (POS) code and modifiers as applicable.

• POS code 02 (Telehealth) should be used for professional telehealth services from a distance site, But for distance site Critical Access Hospitals (CAHs) institutional claim should use modifier GT as institutional claims do not use POS code.

• Modifier GQ (Asynchronous (not real time) telecommunications system) required for providers participating in federal telehealth program in Hawaii and Alaska.

• Modifier G0 (G Zero) - Telehealth services furnished for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke.

• Modifier 95 – This is same as modifier GT and currently being used by some private payers. You need to check with your payer if they need this on the claim.

• HCPCS code Q3014 – This is to be used by originating site for billing to get reimbursement for their fee (Approx. $26.65).

#Medicare #Telehealth #Telemedicine #Modifier