TeleHealth Billing Good to Know
- Dawn Mackey
- Stefanie McCully
Contact payors directly to confirm:
If the client’s specific policy plan covers telehealth
If telehealth services are allowed & what is needed to be able to provide services
If telehealth is allowed, what billing modifiers and service location should be used? What HCPCS and CPT codes apply for reimbursement?
If rates will differ from telehealth vs. in person
Which providers are eligible for reimbursement
If there are any specific documentation requirements for reimbursement
If telehealth will be allowed under your current client authorization or if a new authorization needs to be requested
Bottom Line: Confirm with your payor AND the client’s specific plan if telehealth services can be reimbursed and which modifier or Place Of Service is required for the claim.
This information is changing constantly so please confirm with your payor, the information below should not be used as a resource to complete your billing, it is intended only as a guide and informational purposes.
# | Description | Good to Know |
|---|---|---|
Place of Service | Unless your payor outlines a different requirement; select 02-Telehealth for place of service when scheduling a client appointment in your Rethink account. | 
|
Which Modifier should I use? | Depending on the payor you may use:
| GT more likely to be used with HCPCS codes or if the payor is not up to date |
Synchronous Telehealth | Either GT or 95 depending on payor | Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified healthcare professional and a patient who is located at a distant site from the physician or other qualified healthcare professional. (most common) |
Asynchronous Telehealth | GQ | The transmission of a patient’s medical information from an originating site to the health care provider at a distant site without the presence of the patient |
Service provided over Telephone | GQ | Verify directly with payor if they are allowing for telephone only services |
What if I am using a Non HIPAA compliant video tool? | Some payors are requiring the Modifier GQ - they may also require use of 02 as POS code depending on payor. | Best Practice is to use HIPAA compliant tools. During COVID-19 some payors are offering access to zoom by request. http://www.magellanprovider.com/media/154064/covid_qa.pdf
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What if I am using a HIPAA compliant video tool? | GT or 95 and/or POS 02 depending on payor requirements |
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Adding Modifier's to Billing Codes and more- (TeleHealth)