This article was updated on May 29, 2020. See below for answers that have been updated.
The Centers for Medicare and Medicaid Services (CMS) has issued guidance regarding the billing of E-Visits and Telephone Services provided by physical therapists, occupational therapists and speech-language pathologists. In this article, I will provide you the information via a question and answer format.
What is the update that CMS released and how does it pertain to the E-Visits and Telephone Services?
Answer (Updated on May 26, 2020)
What codes were added to the list of “sometimes therapy” services?
Since the above codes have been designated as “sometimes therapy” services, what modifier(s) must be appended to them on the claim form?
Answer (Updated on May 26, 2020)
What is the effective and implementation dates of these changes?
Answer (Updated May 26, 2020)
Can a physical therapist assistant or occupational therapy assistant provide an E-Visit or Telephone Service?
Can E-Visits and Telephone Services be billed by Institutional Providers such as skilled nursing facilities, hospital outpatient therapy departments, rehabilitation agencies, comprehensive outpatient rehabilitation facilities and home health agencies providing outpatient therapy in the Medicare beneficiaries home and have these services paid for by the Medicare program?
Answer (Updated May 21, 2020)
How can I access this information straight from CMS
I hope you found this article helpful. Watch for additional questions as well as updated responses if CMS clarifies any of the above information or provides additional guidance and instruction. Thank you for being a Gold Member!
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We are a rehab agency billing on a UB-04 and we just got paid for 98968 by Medicare.
Lets hope you were paid correctly. Many MACs are not paying the therapy claims correctly, whether its E-Visits, telephone services or telehealth.
Novitas is denying all e visits and telehealth claims… will call them to clarify what is wrong.. just fyi
That does not surprise me especially if you are appending the GP, GN or GO modifier to the G2061-G2063 codes. What modifier(s) did you append to the G2061 – G2063 codes when submitted?
They told us to use POS 11 and not use the GP code….
So no POS modifier (11 or 12) is required for e-visits?
On a 1500-claim form, a POS code is required.
We are a outpatient rehab facility and bill 95% to Michigan Auto No-Fault for Vocational Services normally we bill out using the 97537 HQ modifier on a 1500 and get reimbursed fine. Currently with the COVID -19 we are using a Zoom Platform and I have AAA advising me they will only reimburse us using the Telehealth CPT codes. Can you tell why? or give me a location to find any CPT codes that would benefit us to get reimbursed at normal rate we bill out at.
You would need to contact the auto carrier and see if they are only paying the CPT codes that the Medicare program allows for telehealth or if they have a list of CPT codes that are paid if delivered via telehealth. If you read this article, you can locate the CPT codes that CMS pays for when delivered via telehealth.
Additionally, can you clarify what the following means: “not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment”?
We are an outpatient PT clinic. We have been paid for all evisits with the attached modifier GP and 95. When I spoke with a MC rep a month ago she told me to use those modifiers because CR was not being accepted at the time. So I rebilled the one claim that was denied and used GP and 95 modifier to all future claims billed and we have received payment for all of them and the secondaries have covered the 20%. We bill using a 1500 form with a POS 2.
I also have received payment from BCBS for all telehealth visits using the same information.