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Modifiers

Marilyn Posted Wed 13th of May, 2020 18:55:21 PM
We are getting different answers. Our providers provide MH counseling in office setting, but due to COvid-19, providers do not go to the office but providing Telehealth Services from home. Which is appropriate to use: pos-02 or pos -11 with a modifier of -GT or-95? Heard that pos -11 with a modifier pay rate is higher in which we are non facility(?).
SuperCoder Answered Thu 14th of May, 2020 04:46:14 AM

Thank you for your Question.

 

 

During this COVID-19 crisis, If providers are providing service from a location other than office then Medicare would be paying the non-facility amount for telehealth services when they are billed with the place of service (POS) the physician would have used if the service had been provided in person (e.g., POS 11 – Office). As per CMS, Place of Service (POS) equal to what it would have been had the service been furnished in-person.

 

Claims with POS 02 (regardless of the physician or provider location) – Telehealth would be paid at the normal facility rate, which is typically less than the non-facility rate under the Medicare physician fee schedule.

 

 

Commercial payers are generally following Medicare’s lead in terms of coverage and policy. However, some commercial payers are requiring some unique modifiers in order to pass their system edits. You would need to reach out to the individual payer to know what modifiers they are requiring for telehealth services.

 

 

Hope that Helps!

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