October 1, 2020
A reminder that for telehealth visits, providers need to bill POS 02 for all services delivered after September 1, 2020, along with an appropriate modifier (95 or GT) appended to the procedure code. Telehealth claims not using POS 02 will be denied and returned.
Refer to your Premera contract for allowable information for virtual care codes. Below is a summary of specific coding information for Premera patients or refer to this Provider News article.
Modifiers:
We require modifiers be appended to the services that are rendered by a provider at the distant site who is viewing the patient located at another site. When billing for a service that’s covered under the member’s telehealth/telemedicine benefit, a modifier below must be added to each procedure code submitted for reimbursement:
- 95 – Synchronous Telemedicine Service Rendered via a Real-time Interactive Audio and Video Telecommunications System
- GQ – Via Asynchronous telecommunications system (e.g. 99201-GQ)
- GT – Via interactive audio and video telecommunication systems (e.g. 99201-GT)
- GT – Via interactive audio and video telecommunication systems (e.g. 99201-GT)
Place of Service Code:
To identify the services using a HIPAA compliant telecommunications methodology, the following Place of Service (POS) code must be used:
- 02 – Telehealth The location where health services and health related services are provided through telecommunication technology
This POS code is used by the provider furnishing telehealth services from a distant site. POS code 11-Office isn’t appropriate for telehealth services rendered via a HIPAA compliant telecommunications system.
Originating Site:
Providers who are located at an “originating site” (where the patient is located) may submit a fee for hosting the patient using the following HCPCS code without any modifiers:
- Q3014 – Telehealth originating site facility fee
Distant site providers are subject to the state laws and scope of practice/license criteria per the state in which the member is located.