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Looking for these answers has been like searching for the proverbial needle in the haystack.
If I had to explain to CMS why clinicians get so anxious dealing with Medicare, the top two reasons would be:
1) Publications written in Medicare-ese don't facilitate easy comprehension. I suggest English as a language.
2) Searching for hours and ending up in the Federal Register, the Social Security Act, the Code of Federal Regulations, and the various other Acts over the last decade that have concerned Medicare...isn't a whole lotta fun. I could have chosen to go to law school - but didn't want to!
The reason I do what I do, is because I don't like giving up! I want you guys to be paid fairly for the good work you do.
I give Medicare some credit - at least they do try to disseminate the information. I haven't seen any Medicare Advantage plans stepping up (yet) to tell us how they will cover telehealth, and how to code it, when the PHE ends. I'll keep looking!
If you want chapter & verse citations, email me and I will send you what I found. Otherwise, you can rely on this (unless the government changes it tomorrow...!)
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Through December 31, 2023, telehealth will continue to be coded with the place of service as if you were seeing the client in person, plus modifier -95.
- Coding this way will ensure payment at the non-facility (highest) reimbursement level.
- As during the PHE, you can use POS 02 or 10, but you will be reimbursed at the lesser facility allowable rate.
- Audio-only services for mental health will be reimbursed through December 31, 2024.
- Until December 31, 2023, code Audio-only telehealth with the place of service as if you were seeing the client in person, plus modifier -93.
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