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

Several people have contacted me recently to ask how long the payers are going to cover telehealth visits. While there have been a few minor updates, I haven't seen anything that specifically changes too much, except that one or two payers have extended their coverage dates and/or cost-sharing guidelines.

I put together the attached quick summary of the codes used for audio/video versus telephone-only visits, the dates of service that are shown in the links (where I've been able to find dates mentioned), and the cost-sharing information. 

Medicare reimbursement for audio-only 

By now, you probably received a second payment from Medicare for any 99441-99443 codes billed prior to Medicare's decision to increase the reimbursement rates. If you have now been paid at 100% of your charged amount, but you did not originally price these codes at the same level as you bill codes 99212-99214, then you will need to go back and do a Clerical Error Reopening to increase your fees and receive yet another payment to true-up to the new Medicare allowable rates for these codes. 

I know this is a posting nightmare for the billers, but Medicare is only going to pay the lesser of either the billed amount or the fee schedule allowable. Hopefully, you have increased your fees now, so all current claims for audio-only services will be paid at the higher amount.

Billing and coding for COVID-19 tests

This is relevant for anybody who is billing for the COVID test. They need to add the QW modifier on these two codes to indicate it is a CLIA-waived test.

HCPCS codes U0002 and 87635 must have the modifier QW to be recognized as a test that can be performed in a facility having a CLIA certificate of waiver. Note that MACs will not search their files to adjust claims already processed prior to implementation of CR 11765 [Implementation Date: May 8, 2020]. MACs will adjust the claims that you bring to their attention. 

MLN Matters Articles
Addition of the QW modifier to Healthcare Common Procedure Coding System (HCPCS) code U0002 and 87635
A new MLN Matters Article MM11765 on Addition of the QW modifier to Healthcare Common Procedure Coding System (HCPCS) code U0002 and 87635 (PDF) is available. Learn about the addition of codes for COVID-19.

IHCP updates reimbursement rates for codes 86328, 86769

Indiana Medicaid (IHCP) issued Bulletin BT202068 on Thursday, May 28. It updates reimbursement rates for COVID-19 testing codes 8628 and 8679, retroactive to DOS May 19, 2020.