Telehealth Place of Service Update

With a recent change to telehealth billing, billers need to be aware of an additional Place of Service code. What changed? Effective January 1, 2022, in addition to the CMS POS code 02, CMS introduced a second telehealth, POS code 10:

  • POS 02 (Telehealth to a client who is not located at home)
  • POS 10 (Telehealth to a client located at home (does not apply to clients in a hospital, nursing home, or assisted living facility)

It is also important to remember that some payers are on board while others are not. Be sure to check with your payers before using these POS codes.

Physicians providing telehealth services have generally not documented in their notes where the patient is calling from since the PHE waivers removed the originating site requirements. Now, it is necessary to ask the patient if they are calling from home and document it.

When performing telehealth services, please communicate the POS to your billers.  Additionally, be sure to append the 95 or GT modifier, if needed, to identify the visit as a telehealth service.

Good news if you provide telehealth services.  CMS is also proposing several new policies regarding Medicare telehealth for the calendar year 2023.  They would make some of the temporary PHE telehealth services available under Category III CPT through CY 2023, to gather more data to support adding more telehealth to the permanent list of services.

These policies would extend the waiver flexibilities, currently in place due to the PHE, to continue for 151 days after the end of PHE, such as allowing telehealth services to be provided in any geographic area and any originating site, including the patient’s home.

The proposed rule can be reviewed for the CY 2023 Medicare Physician Fee Schedule at: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-proposed-rule

We are happy to assist you with claims issues and other topics related to eye care.  Check back often for updated News Items related to billing, documentation, and operations related to your practices.  Stay safe.

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