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Marilyn Posted Thu 14th of May, 2020 09:35:20 AM
Due to COVID19, we experienced a change where HR is staffing new providers that will only be telehealth providers (meaning they will never be associated with an office location) or the provider have not been to an office. In this case, can box 32 on the CMS1500 be left blank OR can the provider's home info be listed as POS (-02)and of course billing under the group? Looking at their NPI# info, there is a primary office location listed associated with the group. Can the listed location be used as POS even though the provider have never been to the location?
SuperCoder Answered Fri 15th of May, 2020 05:16:42 AM

Hi Marilyn,

Hope you are keeping well.

During this Pandemic, COVID-19 crisis, as per new rules Medicare will pay 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 i.e. POS 11. Physicians should append modifier -95 to the claim lines delivered via telehealth. Claims with POS 02 – Telehealth will be paid at the normal facility rate, which is typically less than the non-facility rate under the Medicare physician fee schedule.

So, it is suggested to use the POS-11 for the following scenarios: Office visit related to COVID-19 testing, Telehealth visit related to COVID-19 testing, Office visit not related to COVID-19, Telehealth visit not related to COVID-19.

Also, append modifier 95 with the service when billed under POS-11 under Telehealth visit related or not-related to COVID-19. However, since you have hired the provider specifically for telehealth service, so POS should be 02 (Telehealth) and on field 32 of the HCFA (CMS-1500) name and address of the facility where services were rendered need to be entered, which is your actual Telehealth office, because this is understood that due to COVID-19 pandemic these services are rendered from resident of the providers. Also, group's NPI# can be used to bill the claims.

Hope this helps!

We wish you to be healthy and safe!

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