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The pMD Guide to Telehealth Reimbursement


Telemedicine has been pushed into the spotlight in recent weeks in light of the COVID-19 coronavirus pandemic. Due to historically variable and restrictive reimbursement policies, many practices are not currently set up to provide virtual care. In light of the profound disruption caused by the pandemic, we are hearing from practices around the country that need to consider offering telehealth and scrambling to do so. Often, they have to consider tomorrow's appointments and wonder will we get paid for these visits? Well, here is what we know:


MEDICARE WILL COVER ALL TELEHEALTH SERVICES

CMS recently announced a major change to its telehealth reimbursement policy. During this crisis, Medicare will pay for telehealth services regardless of the originating site dating back to March 6, 2020. As long as visits are conducted via video, those visits that would normally be provided in an office, hospital, clinics or other settings, can now be done virtually, even from a patient's home. These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.

The codes that can be billed for what Medicare defines as “telehealth services” are typically evaluation and management (E/M) codes, such as 99213, combined with a telehealth Place of Service (POS) and potentially a modifier if required by the commercial payor.

PLACE OF SERVICE 02:

According to CMS, POS 02 is defined as “the location where health services and health-related services are provided or received, through a telecommunication system.” CMS has replaced the GT modifier with POS 02 and can be used when billing CMS claims for synchronous telemedicine visits. 

GT MODIFIER:

Although it has been widely replaced by the 02 POS location, some private payors still recognize and prefer the GT modifier to indicate a service was rendered via synchronous telecommunication.

MODIFIER 95:

Modifier 95 is a fairly new modifier and used only when billing to private payers to indicate services were rendered via synchronous telecommunication. It is important to note that Medicare and Medicaid do not recognize modifier 95. As with the GT modifier, not all payers recognize modifier 95. 

WHAT ABOUT MEDICAID AND COMMERCIAL PAYERS?

At this point, commercial and Medicaid coverage is still much less consistent. While U.S. Representatives have recommended CMS to encourage states to cover all telemedicine services and work with them to expand their capability to do so, reimbursement remains subject to state-specific requirements. In a similar vein, private health insurers, including Aetna, Cigna, Humana, United Healthcare will also cover telehealth for the next 90 days in some states, but the coverage also varies state by state. We encourage practices to always confirm local guidelines.

GET STARTED WITH pMD TELEHEALTH TODAY

pMD® Secure Messaging™ telemedicine capabilities allow practices to connect, triage, and follow up with patients through secure, HIPAA-compliant text, video, and voice calling. Easily invite patients to download the app at no cost to facilitate timely communication when it matters most:

* provide health safety guidelines and recommendations
* share important practice updates and announcements
* outreach to your most vulnerable patient population
* perform telehealth visits with patients advised not to leave their homes

No matter the specialty, pMD is highly customizable to fit your practices’ needs and workflows. View additional information, resources, and FAQs about setting up and providing telehealth services with pMD and how to get started now.   

For help setting up patient communication or to contact pMD customer support, please give us a call at 800-587-4989, x1 or email support@pmd.com.

Stay safe, everyone!

To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.
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