As telehealth services, also known as telemedicine, increase in popularity, it’s critical to identify those services exchanged via electronic encrypted and HIPAA compliant telecommunications. These services are NOT coded like services that are rendered as part of an in-office face-to-face visit with a provider. There are key coding elements that must be present to identify the service as a telehealth/telemedicine service.
The payment policy Telehealth/Telemedicine Services has key criteria that need to be included to identify a telehealth/telemedicine service:
We require modifiers be appended to the services that are rendered by a provider at the distant site who is viewing the patient located at another site. When billing for a service that’s covered under the member’s telehealth/telemedicine benefit, a modifier below must be added to each procedure code submitted for reimbursement:
To identify the services using a HIPAA compliant telecommunications methodology, the following Place of Service (POS) code must be used:
This POS code is used by the provider furnishing telehealth services from a distant site. POS code 11-Office isn’t appropriate for telehealth services rendered via a HIPAA compliant telecommunications system.
Providers who are located at an “originating site” (where the patient is located) may submit a fee for hosting the patient using the following HCPCS code without any modifiers:
Distant site providers are subject to the state laws and scope of practice/license criteria per the state in which the member is located. For more information, review the payment policy.
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