Updates and reminders
Published November 4, 2021
As telehealth encounters continue to be delivered in response to COVID-19, these visits need to be documented and billed correctly to distinguish a virtual visit from an in-person office visit. There are similarities in the documentation
and billing guidelines, but there are some key significant differences that need to be called out to identify the service as a telehealth visit.
Documentation
Telehealth visits with a patient, whether performed via audio and video, audio only, or an online digital interaction, are required to be permanently documented and stored in the member’s healthcare record. Permanent documentation in the member’s medical
record must include the following additional requirements:
- Identification in the notes where the patient is located, where the distant site provider is located, what kind of telecommunications modality is being used (audio/video, audio only, digital online), and the person(s) present with the patient when hosting
a patient at an originating site
- Summary of information discussed with the patient and plan of care/treatment
- Any communications/files/documents
- Patient consent to be seen via an “audio only” virtual visit or to consult with another specialist without the patient being present. NOTE: This consent should be obtained prior to the actual rendering of any service
- Text messages or emails sent to or received from the member
Place of Service (POS) Codes and Modifiers
A telehealth encounter is identified by two key data elements to distinguish the encounter with the member from an actual face-to-face, in-office encounter:
- Place of service
(POS) code “02”:
- POS code 02 is used by the physician or other qualified healthcare professional providing the telehealth service from the site
- POS code 11 is not appropriate for a telehealth encounter rendered via a telecommunications system
- Modifiers: The provider(s) at the distant site who is providing a medical service via a telecommunications method is required to append one of the following modifiers to the procedure codes:
- 95 - Telemedicine Service Rendered via a Real-time Interactive Audio and Video Telecommunications System
- GT - Via interactive audio and video telecommunication systems
- GQ - Via Asynchronous telecommunications system (store and forward)
- G0 - Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke
Sign into your secure provider website to view the criteria in the Telehealth/Telemedicine
Services Payment Policy to view the policy.