Just when you thought you got your head semi-wrapped around Medicare telemedicine rules, they go and throw it out the window! On March 30, CMS issued an Interim Final Rule and released new guidance on how to code and bill for rapidly evolving telehealth services.

Before you file another claim, here are the three sweeping changes you must implement now. Taking the time to apply these new telehealth billing rules now means you’ll receive claims payment faster – and face fewer denied claims in the future.  

Apply Modifier 95 to All Medicare Claims

There has been a lot of confusion over what modifier to use. And the COVID-19 National Stakeholder Call held on March 31, 2020 ended the various guidelines. You’ll now use modifier 95 on all Medicare claims – professional and facility, clarified CMS Administrator Seema Verma. Modifier 95 indicates the office visit was performed via telehealth – and gets the claim to process around Medicare’s historic system edits.  

Use Usual Place of Service

If you’ve been confronted with a waive of telehealth denials, the new CMS place of service guidance should eliminate a major trigger. You will now use the the intended originating site of where you would have provided the service outside of COVID-19. This replaces the earlier CMS instruction of using Place of Service 02 for telehealth. Example: If you would have seen the patient in the office with place of service (POS 11), then that’s the POS you report now.

Denial busting claim story: Modifier 95 with POS 11 indicates the office visit was performed via telehealth. This is Medicare’s way of overriding the bundle that denied claims with an office visit CPT code (99201-99215) with POS of 02 (Telehealth).  

Apply Digital Visits to New Patients Too

The new rule also allows you to treat new patients via virtual check-ins. Codes G2010 and G2012 for digital communication services were previously restricted to established patients only. They now are applicable to new patients too.