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2017 Telehealth Services Updates

Mar 8, 2017

Telehealth services are being offered as an alternative to face-to-face encounters by many physicians and health care facilities across the country. Also referred to as telemedicine, telehealth services allow providers to treat their patients remotely, via telephone or video calls. One of the upcoming challenges for health care will be a shortage of providers and health care facilities, especially in rural areas of the country. Telehealth is a great way for providers to connect with patients who may not have physical access the care they need.

There are several updates in billing guidelines for these services that went into effect January 1, 2017. These changes include additional updated CPT® and HCPCS Level II codes for end-stage renal disease (“ESRD”)  as well as critical care consultations. A new place of service code 02 was also added which indicates that it is a telehealth service from a remote site. When utilizing the new place of service code, CMS requires the use of modifiers GT and GQ even though they are aware this is repetitive. A new modifier, 95,  was also added to indicate a service generally reported as a face-to-face service that is performed via a real-time interactive audio and video telecommunications system.

Before beginning any new services, providers, facilities and their billing staff should always consult with local and state guidelines. In addition to Medicare and Medicaid, commercial payers and managed care payers have implemented their own billing and payment guidelines for telehealth services. These carriers should be contacted directly as the rules may vary by plan. These guidelines should be carefully reviewed to ensure claims are being billed appropriately and providers are being reimbursed for the services they provide. Covered services for telehealth may also vary by state. There may be additional regulations based on what state the physician is licensed in, so it is best to review each state’s guidelines.

Medicare provides a full list of updated CPT® and HCPCS Level II codes eligible for reimbursement as well as guidelines on qualifying locations of the patient and qualified practitioners who may provide telehealth services on its website.

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