By Carol Hoppe, CPC, CCS-P, CPC-I
MedLucid Solutions

This week has brought with it some real anxiety and game changes in terms of billing for telehealth under the COVID-19 Public Health Emergency (PHE).

What was previously published by CMS regarding telehealth services being billed with place of service (POS) 02 took a drastic turn on Tuesday, when the MLN Connect Special Edition reported Medicare would now cover more than 80 additional services not previously on the Medicare approved telehealth code set. The article stated that the POS should match what would have been used prior to this PHE, along with modifier 95 to indicate that the service was performed via telehealth.

The article goes on to state:

“Traditional Medicare telehealth services professional claims should reflect the designated POS code 02- Telehealth, to indicate the billed service was furnished as a professional telehealth service from a distant site. There is no change to the facility/non-facility payment differential applied based on POS. Claims submitted with POS code 02 will continue to pay at the facility rate.”

The news alarmed physician practices that are still seeing patients from their office as well as at home via telehealth. We have been told all along that providers would be paid at the same rates as if they had seen the patient in the office face-to-face at the higher non-facility rates, when appropriate. Some practices have contacted the ISMA saying they already had started receiving reimbursement at the lower facility rates.

The Interim Proposed Rule, which is scheduled to be published Monday, April 6, clearly states the intent was lost somewhere in the MLN Connects article translation:

"When a physician or practitioner submits a claim for their services, including claims for telehealth services, they include a place of service (POS) code that is used to determine whether a service is paid using the facility or non-facility rate. Currently, CMS requires that claims for Medicare telehealth services include the POS code 02, which is specific to telehealth services...

…on an interim basis, we are instructing physicians and practitioners who bill for Medicare telehealth services to report the POS code that would have been reported had the service been furnished in person. This will allow our systems to make appropriate payment for services furnished via Medicare telehealth which, if not for the PHE for the COVID-19 pandemic, would have been furnished in person, at the same rate they would have been paid if the services were furnished in person.

Because we currently use the POS code on the claim to identify Medicare telehealth services, we are finalizing on an interim basis the use of the CPT telehealth modifier, modifier 95, which should be applied to claim lines that describe services furnished via telehealth.

We note that we are maintaining the facility payment rate for services billed using the general telehealth POS code 02, should practitioners choose, for whatever reason, to maintain their current billing practices for Medicare telehealth during the PHE for the COVID-19 pandemic."

Until this Interim Final Rule is issued in the Federal Register and the Medicare Contractors are given further instructions from CMS, Medicare claims will continue to be processed under the guidance given in the MLN Connect article.

For those claims that have already been submitted based on previous guidance from CMS, WPS Medicare has advised that you wait until the claims have processed before you resubmit corrected claims. Resubmitting before the original claim has fully processed will likely result in denials for duplicate claims and potentially duplicate payments that will need to be recouped in the future.

Once the Final Rule is published, we will update all online resources that were previously on the ISMA COVID-19 Resources page and make those available to the public.