**Just a reminder, as of Jan 1, 2025 telehealth for Medicare is extended until March 31, 2025. Congress needs to act by then.
Coding telehealth visits changes faster than the weather here in New England. The resources on the site relate to Medicare policy and CPT codes and rules. Unfortunately, they don’t address individual commercial payer policies.
- There are two new place of service (POS) codes for coding telehealth visits. Use these POS codes. They are in the front of theh CPT book.
- Place of service codes determine if the encounter is paid at the facility or non-facility rate. The non-facility rate is a higher rate of reimbursement.
Beginning January 1, 2024, claims submitted with POS 02 will be pad at the lower, facility rate.
POS 02: Telehealth Provided Other than in Patient’s Home
Description: The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology. (Effective January 1, 2017) (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.)
Use this POS for patients who go to a medical facility (originating site) to have telehealth service with a practitioner at a distant site. For example, patient goes to an ED in a rural area, and has a telehealth service with a specialist in a tertiary care center.
POS 10: Telehealth Provided in Patient’s Home
Description: The location where health services and health related services are provided or received, through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.)
CMS has a broad definition of “home.” See their quote below.
What about a patient in their car?
From the 2023 Final Rule, p. 193. “We remind readers that we defined “home” in our CY 2022 PFS final rule (86 FR 65059)to include, as: “both in general and for this purpose, a beneficiary’s home can include temporary lodging, such as hotels and homeless shelters. We also clarified that for circumstances where the patient, for privacy or other personal reasons, chooses to travel a short distance from the exact home location during a telehealth service, the service is still considered to be furnished ‘in the home of an individual’ for purposes of section 1834(m)(4)(C)(ii)(X) of the Act.”
Use POS 10 in this situation.
Coding telehealth visits
- Coding for telehealth
- Telemedicine in RHCs and FQHCs
- Is it or isn’t it a telehealth service
- Payment for telephone calls
- Overview of Medicare telehealth services
- Interprofessional Internet Consultations
- CPT® codes (99421-99423) – and payment for – online digital evaluation and management (E/M) services
- Virtual communication: two new HCPCS codes G2010 and G2012
- When to use CPT modifier -93
- Modifier 95, 93: Telemedicine
- Modifier CS
- Medicare changes telehealth rules, again
Get more tips and coding insights from coding expert Betsy Nicoletti.
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