High-Tech Health-Check
It is first important to define what we mean by telehealth and the requirements that must be met for a telehealth service to be reimbursed. According to a February 2024 Medicare Learning Network (MLN) article (entitled “Telehealth Services”), Medicare Part B pays for services that a physician or practitioner provides “via 2-way, interactive technology (or telehealth).” We’re told that “Telehealth substitutes for an in-person visit, and generally involves 2-way, interactive technology that permits communication between the practitioner and patient.”
That technology generally involves real-time audio/visual communication that is HIPAA compliant. However, Section 4113 of the Consolidated Appropriations Act (2023) allows you to use audio-only telehealth for “some non-behavioral telehealth through December 31, 2024.” As long as these technical conditions are met, Medicare will reimburse providers for services included in the approved telehealth services list (see list at List of Telehealth Services | CMS ) as if the patient had seen the practitioner in person. For example, if a patient has a level-three evaluation and management (E/M) telehealth visit with Dr. John Smith, the good doctor would receive the same reimbursement had the visit taken place in his office/clinic.
Location, Location, Location
As our friends in the real estate industry are quick to point out, “it’s all about the location.” And that is particularly true when it comes to medical claim submissions. Providers are required to include a code on the claim form indicating where the service took place. This “place of service” (POS) code will often have a direct impact on the level of payment the provider receives for the service in question. It is therefore imperative that the POS code is accurate.
But there seems to be some confusion on the part of many in the healthcare field concerning the place of service in a telehealth encounter. Part of the confusion is due to the changes that took place in telehealth rules during and after the public health emergency (PHE) related to the outbreak of COVID in the United States. Another contributing factor to the uncertainty is the divergence in POS rules relative to telehealth among the varying payers. It may be helpful, then, to survey the current landscape of telehealth POS requirements.
You will recall that, in 2023, Medicare required you to report the place of service you would have billed had you seen the patient in person. For example, if the patient was at home, and the physician was in the office, the physician would have reported the telehealth service as POS 11 (office), along with the 95 modifier, indicating a telehealth service.
For 2024, Medicare no longer requires you to report POS codes 11 (office) or 21, 22, and 24 (facility). Instead, you are to report either POS 02 (telehealth provided in other than patient’s home) or POS 10 (telehealth for services when the patient is in their home). In addition, you no longer need to report modifier 95 since POS 02 and POS 10 are defined as telehealth services.
There is an exception to this 2024 Medicare rule. It involves a scenario where the practitioner is in the hospital and the patient is at home during the virtual visit. For this circumstance, the Centers for Medicare and Medicaid Services (CMS) offered the following clarification: “We wish to clarify that for telehealth services when the clinician is in the hospital and the patient is in the home, the billing practitioner should use a hospital POS code along with modifier 95.”
In reviewing the requirements of third-party payers, we have noted that most of them follow Medicare’s 2024 policy of using either POS 2 or POS 10, based on the where the patient was at the time of the telehealth service.
Supporting Your Case
In order for us to accurately code your telehealth claim from a POS perspective, we need the practitioner to provide, at a minimum, the following documentation elements:
- The patient’s agreement to a telehealth visit
- The patient’s location during the visit
- Your location during the visit
- The platform being used with clear indication of whether the visit was via audio-visual or audio only
Beginning in 2025, the Medicare telehealth rules are likely to change once again. We will keep you apprised of any proposed or final changes as they become available. If you have questions about this topic, please feel free to contact your account executive.