The pandemic has changed us all in ways that are too numerous to count. This is the case in the therapy billing world too.
In a previous post, we discussed how much location matters when billing telehealth services. Given the greater demand for teletherapy, the Centers for Medicare & Medicaid Services (CMS) has seen fit to amend certain billing codes in response. To keep up and bill correctly, it is crucial that you are aware of changes and modifications to the place of service codes for telehealth today.
How Have Place of Service Codes (POS) Changed?
POS codes are two-digit codes reported on Form CMS-1500 meant to help clarify those services rendered and ensure that claims are appropriately paid. As you may recall, on the HCFA 1500 form, telehealth providers were required to use the E&M CPT location code of 02 with the modifier GT or 95. Without the POS 02 code, the telehealth services would not be accepted by the payer.
The idea of the current changes is to improve the reporting of services you are offering your patients away from your office as well as the coverage of that therapy.
This, of course, is only a good thing if you know exactly what to do and when. So let’s break this down clearly together below:
Billing Code POS 02
First, understand that this existing code has been revised. The POS 02 code, is now described as telehealth provided other than in the patient’s home. By using this code, you are indicating that your telehealth service was administered to a client who was in a location other than their home.
This means that
- your therapy services and, any related services, were supplied and obtained, via telecommunication technology, such as Zoom or any such teleconferencing medium that is HIPAA compliant.
- your patient was not located in their home while working with you. In other words, to use the code POS 02 they can be anywhere but their own home environment.
What if they did work with you from home? There is now an entirely new code for that type of care below.
Billing Code POS 10
**NOTE: Do not use this code for Medicare.
Medicare is still requesting 11 as the location and 95 as the modifer. (April 2022)
Post-pandemic, this new billing code provides the specific distinction and soon payers will require the distinction. This change was made to accommodate the 2021 Consolidated Appropriations Act.
This allows for a patient’s home to be the site of all care. This includes diagnosis, evaluation, and treatment for any and all mental or behavioral health conditions.
With this being the case and endorsed for public safety, you can confidently use this code to indicate that your telehealth service was appropriately and professionally administered in your patient’s place of residence.
Before you bill, do be sure to wait until the time is right
Now, that you are fully informed, be patient. To start using this code right away will likely meet with missteps and frustration. Unfortunately, systems are still rejecting the new code. You will need to wait until April of this year (2022) to employ POS 10. At that point, CMS will fully implement the updates.
Still Feeling a Bit Unsure?
Are you ready to jump into billing or do you still have questions? It’s perfectly okay if you do. These are uncertain times. You have a lot on your plate. Maybe you wonder whether the modified POS Code 02 will be affected by the end of COVID-19? Or do you wonder how you will know how to adjust your codes when our official public health emergency (PHE) finally comes to an end? Perhaps you are feeling uncertain about the number of changes occurring in the billing world in general!
You are not alone and you don’t have to navigate it all on your own.
We are here to help you feel confident and secure as you set about properly identifying your services, meeting your client’s needs, and fairly (and legally) receiving payment.
You Have Telehealth Billing Support Available to You Right Now
It is perfectly okay if you have more telehealth billing questions! I run a Facebook group for insurance billing for telehealth to help you in real-time. Link here: http://bit.ly/2kKfZXp and please join us soon. Let’s talk things through together with others who looking to master telehealth billing just like you.