COVID-19 and Telehealth Services
Due to the coronavirus (COVID-19), I am receiving many questions regarding telehealth and the ability for physical therapists, occupational therapists and speech-language pathologists to provide telehealth services and to have those services reimbursed by the Medicare program and private/commercial insurance carriers. See below for some of the common questions I receive and the answers as of March 13, 2020.
Question
With the Centers of Medicare and Medicaid Services changing the rules and regulations for telehealth services due to the coronavirus (COVID-19), does this now mean physical therapists, occupational therapists and speech-language pathologists can now provide telehealth services to Medicare beneficiaries, bill their respective Medicare Administrative Contractor (MAC) and be paid by the Medicare program?
Answer
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Question
Can I issue the Medicare beneficiary an Advance Beneficiary Notice of Noncoverage (ABN) and collect cash from the Medicare beneficiary for telehealth services?
Answer
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Question
Will private/commercial insurance carriers pay for telehealth services for physical, occupational and/or speech therapy services due to the outbreak of the coronavirus (COVID-19)?
Answer
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Question
If I am in private practice and provide telehealth services to a patient of mine, what place of service code do I use on the 1500-claim form?
Answer
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If we were to issue and ABN to a Medicare patient, what CPT code would you document under?? Self management training? Thanks for all the help.
Document or bill?
In Washington state, OT and PT are moving to telehealth virtual sessions for established patients due to quarantine. The information we get is all over the place regarding coverage and coding by private insurance companies. What is the correct CPT code for an OT session done virtually for an established patient? Is this CPT 99423? I know place of service is 02 for telehealth and modifier 95. Please advise.
I just updated the article so go and read an additional question and answer that was posted.
Which CPT code, place of service code and modifier does a physical therapist need to report for telehealth. I noted your comment on March 13th regarding updating the article. I could not locate the information.
thank you
I just added an additional question regarding place of service code. You would need to check with each insurance carrier regarding do they pay for telehealth services and if yes, what CPT codes and/or modifiers do I use.
Medical offices are now being able to do telephonic visits (audio, no video) and be reimbursed. Is there any talk that this may be an option for PT/OT/SP?
None that I am aware of.
As I am reaching out to payors regarding authorization and billing for e-visits / telehealth my list of questions continues to grow. Do you have a quick reference /suggested list of questions we might refer to as guidance – with goal of getting all info in one call with each payor?
Simple questions for telehealth are as follows:
1. Do you pay for telehealth services for physical, occupational and/or speech therapy?
2. If yes, what CPT code(s) can I use?
3. If yes, must it be synchronous communication or can it be asynchronous communication
4. If no, can I bill the patient cash for this non-covered service?
You also need to look at your contract as well as any payer policies online.
By no means is this list exhaustive. You need to know the rules and regulations pertaining to telehealth including HIPAA.
Is this still true as of today March 19th? Did Medicare update this rule to now include PT/OT/St?
No changes. Telehealth is still not payable by Medicare for PT, OT and SLP.
Is there a difference between telehealth and e-visits and would e-visits be payable under Medicare?
Yes, there is a difference between telehealth and E-Visits. Here is an article on E-Visits. https://gawendaseminars.com/e-visits-for-therapy-services/
Can a clinic charge a location of “home care” as the location code, but provide the visit vis telehealth means? (I am 100% sure the answer is no, but am asking because I’m hearing that this is happening).
Place of service code for telehealth is 02 unless an insurance carrier instructs you otherwise.
Hello, I know we need to have the CR modifier with the G2061-G2063 codes for Medicare but do we need to apply the KX modifier (if the patient already hit the soft cap) and GP modifier?
We are waiting for clarification from CMS on your questions.
When the patient has reached his PT soft cap via telehealth, which needed the modifiers GP & 95, where do we add the KX when there are only 2 rows to add modifiers?
That would depend on your system. This is not a question I can answer.