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As telehealth continues to become a more common form of therapy due to COVID, the procedural coding is also evolving with the times. Effective January 1st, 2022, there is a new place of service (POS) code 10 for telehealth, while the existing POS code 02 should continue to be used when telehealth is provided anywhere other than a patient’s home.
Here’s the determination as per CMS guidelines:
POS 02: Telehealth Provided Other Than in Patient’s Home – The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
POS 10: Telehealth Provided in Patient’s Home – The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.
Also introduced is a new modifier 93 for audio-only telehealth, also known as “synchronous telemedicine.” According to the AMA:
“Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. The totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.”
Commercial insurance companies and Medicare will be accepting this new coding in the coming months, but it’s good to be informed and ready for the impending changes. Not only can it help you to avoid denials, but you can also modify (no pun intended) your therapy to include audio-only sessions if you and/or your patient so desire.
Contact the payer to find out whether it is now covering these new codes, or when they will be in the future. If you aren’t including a POS code for each billed session, start doing it! And don’t forget the telehealth modifier (95 or GT) to identify it as such. COVID may subside, but it doesn’t look like telehealth will follow suit. It’s here to stay, so join the evolution!
Alex is an industrial-organizational psychologist and mental health billing consultant, and helps mental health professionals collect more revenue as the owner of ePsych Billing.
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