Telehealth Billing Basics

Place-of-service codes are crucial in telehealth billing as they indicate where the patient received the service. For example, if a patient receives a consultation via video conference, the place-of-service code should be 02, indicating that the service was provided through telehealth. However, if the wrong code is used, such as code 11 for an office visit, the claim may be denied. I've seen this happen on several occasions, resulting in delayed reimbursement for our clients. To avoid this, it's essential to train your billing staff to use the correct place-of-service codes for telehealth services.

In addition to using the correct place-of-service code, it's also important to use the correct modifier. For telehealth services, modifier 95 is used to indicate that the service was provided via telehealth. This modifier should be appended to the CPT code for the service being provided. For instance, if a provider is billing for a psychotherapy session via telehealth, they would use the CPT code 90832 with modifier 95.

A common mistake that can lead to denials is not using modifier 95 when billing for telehealth services. Without this modifier, payers may not recognize that the service was provided via telehealth, and the claim may be denied. To avoid this, it's essential to ensure that your billing staff is trained to use modifier 95 when billing for telehealth services.

In addition to not using modifier 95, another common mistake is using the wrong modifier. For example, some providers may use modifier 93, which is used to indicate that the service was provided via phone, rather than modifier 95, which is used for telehealth services. This can lead to denials and delayed reimbursement. It's essential to ensure that your billing staff is trained to use the correct modifier for the type of service being provided.

To avoid modifier mistakes, it's essential to have a clear understanding of the different modifiers used in telehealth billing. For example, modifier 93 is used for phone services, while modifier 95 is used for telehealth services. By understanding the differences between these modifiers, you can ensure that your billing staff is using the correct modifier for each service, reducing the risk of denials and delayed reimbursement.

In my experience, the most common modifier mistakes occur when billing for psychotherapy sessions via telehealth. For instance, if a provider is billing for a group psychotherapy session via telehealth, they would use the CPT code 90853 with modifier 95. However, if they use the wrong modifier or forget to append modifier 95, the claim may be denied. To avoid this, it's essential to have a clear understanding of the CPT codes and modifiers used for telehealth services.

To improve reimbursement for telehealth services, it's essential to ensure that your billing staff is trained to use the correct place-of-service codes and modifiers. This includes using the correct CPT codes for the services being provided and appending the correct modifier, such as modifier 95 for telehealth services. By ensuring that your billing staff is using the correct codes and modifiers, you can reduce the risk of denials and delayed reimbursement.

In addition to using the correct codes and modifiers, it's also essential to ensure that you have a clear understanding of the payer's policies and procedures for telehealth services. This includes understanding the payer's requirements for documentation, including any specific forms or templates that must be used. By understanding the payer's policies and procedures, you can ensure that your billing staff is submitting complete and accurate claims, reducing the risk of denials and delayed reimbursement.

For example, some payers may require that providers use a specific template for documenting telehealth services. If the provider does not use this template, the claim may be denied. To avoid this, it's essential to ensure that your billing staff is trained to use the correct documentation templates for each payer, reducing the risk of denials and delayed reimbursement.