Maximizing Telehealth Reimbursement: Navigating Medicare Billing, Coding, and Place of Service (POS) Requirements

Maximizing Telehealth Reimbursement: Navigating Medicare Billing, Coding, and Place of Service (POS) Requirements

As the healthcare environment continuously evolves, telehealth remains a cornerstone for providing Medicare Part B services to beneficiaries. Recent updates from the Centers for Medicare & Medicaid Services (CMS), effective January 1, 2024, bring substantial changes to telehealth reimbursement policies, necessitating a comprehensive understanding of billing, coding, and Place of Service (POS) requirements for healthcare providers.

Expanding Telehealth Code List: CPT & HCPCS Codes for Telehealth

CMS’s expansion of the Medicare telehealth code list for calendar year (CY) 2024 underscores the growing importance of remote care delivery. New additions include CPT® Category III codes 0591T – 0593T for health and well-being coaching services and HCPCS Level II code G0136 for social determinants of health risk assessment, reflecting the diverse range of services now accessible via telehealth.

Policy Changes for Telehealth Services

CMS has extended many telehealth flexibilities introduced during the COVID-19 public health emergency through December 31, 2024, with significant policy changes:

• Telehealth originating sites now encompass any location in the United States where the patient is, including their home.
• Continued payment for telehealth services provided by rural health clinics and federally qualified health centers.
• Postponement of the necessity for an in-person appointment prior to starting mental health telehealth services and for subsequent check-ins.
• Teaching physicians are authorized to use real-time audio and video communication technology during virtual services conducted by residents.
• Removal of frequency limitations for subsequent inpatient visits, subsequent nursing facility visits, and critical care consultations.
• Permission for hospitals and other providers to continue billing for certain services remotely, with exceptions such as outpatient hospitals no longer requiring patient homes to be registered as provider-based entities.

Understanding Place of Service (POS) Requirements

Effective January 1, 2024, CMS introduced new POS codes tailored explicitly for telehealth services:

• Use POS 02-Telehealth when services are provided at an originating site other than the patient’s home.
• Utilize POS 10-Telehealth when the patient receives care from their home.

Telehealth Reimbursement Billing and Coding Considerations

Accurate claims reporting is essential for ensuring proper reimbursement for telehealth services. Modifier 95 is required on claims from all providers except critical access hospitals (CAHs) billing under Method II, where modifier GT is used. Additionally, the telehealth originating site facility fee is 80 percent of the lesser of the actual charge, set at $29.96 for CY 2024 services.

As Medicare telehealth policies evolve, medical coders fill the important role of translating healthcare services into accurate billing codes. With recent changes effective January 1, 2024, including expanded code lists and revised POS requirements, their expertise is vital for optimizing reimbursement while ensuring compliance and enabling seamless delivery of telehealth services to Medicare beneficiaries.

Are you looking to stay updated and well-versed in the latest telehealth coding practices and resources? Our telehealth coding support solutions and education services provide comprehensive guidance and training to help you navigate the complexities of telehealth coding with confidence. Whether you’re a seasoned professional or just starting out, our resources offer valuable insights and tools to optimize your coding practices and ensure accurate reimbursement. Stay ahead of the curve with our telehealth coding resources and elevate your coding proficiency today.