Aug 21st, 2020 - sunshine1991
I am billing an office visit 99213 with modifier 25 with pos 2 for telehealth also need to add the 95 modifier also billing for 90833. Do I put modifiers 25 and 95 on the same line with 99213?
Sep 8th, 2020 - ChrisW 256 1
re: Two modifiers
There are several considerations that need to be made when billing for a telehealth service, different payers may have different policies regarding the use of these modifiers, I would suggest consulting your payer. Without knowing the scenario, I could not advise the use of the modifiers. However, with that being said, if all the stars align, then the use of modifier 95 on both lines is acceptable as it is an informational modifier and does not affect payment. (the informational modifier always goes second, after any payment modifiers).
Here are a few other considerations, when reporting Telehealth services.
• You may use either GT or 95 modifiers depending on the payors' preference.
• If related to COVID use Modifier CS after March 2020, report CS first then 95.
• If billing Medicaid, states may select from a variety of HCPCS codes (T1014 and Q3014), CPT codes, and modifiers (GT, U1-UD) to identify, track, and reimburse for telemedicine services.
• Modifier 95 may only be appended to the services listed in Appendix P the list of CPT codes for services that are typically performed face-to-face but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
• Are you billing for a Medicare beneficiary? If so, there are different rules that apply. For example, according to CMS MLN on Telehealth service,
o “Clinical psychologists (CPs) and clinical social workers (CSWs) cannot bill Medicare for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services. They cannot bill or get paid for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838.”
o In addition, if it is a Medicare beneficiary in Alaska or Hawaii there are different rules, they require the GQ modifier for example 99213-GQ.
CMS-Telehealth Services- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
List of Telehealth Services- https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
UnitedHealthcare- Telehealth and Telemedicine Policy, Professional- https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Telehealth-and-Telemedicine-Policy.pdf