CMS Telehealth Billing Correction
Under the telehealth coverage expansion, CMS has revised its reimbursement policy. Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth.
CMS has made a change to the place of service (POS) and modifiers available to submit on telehealth claims. This change impacts professional claims for telehealth services rendered on or after March 1, 2020, and for the duration of the public health emergency.
The POS should be equal to what it would have in the absence of a public health emergency and must include modifier 95, indicating that the service rendered was actually performed via telehealth. The difference on an E&M claims is on average between $20 to $25.
Telehealth claims submitted with a POS 02 will be paid at the facility rate and telehealth claims submitted with the usual POS (i.e. 11) plus the modifier 95 will be paid the professional rate. Since both POS are valid, claims with the POS 11 are valid and accepted in the AdvancedMD Claim Inspector.
For questions on correcting telemedicine visits that have already been submitted with a POS of 02, please contact your Medicare provider, also known as Medicare Administrative Contractor (MAC). Click here to find the MAC for your area MAC Website List.