Does TRICARE Pay for Telehealth for Outpatient Therapy?
Does TRICARE pay for telehealth services for outpatient physical, occupational and/or speech therapy services?
What CPT code(s) do I use to bill for telehealth for TRICARE beneficiaries?
The TRICARE Policy Manual is not clear on what code(s) to use for telehealth services. Your first option is to contact TRICARE.
Per the TRICARE Policy Manual, April 2015, Change 60 (March 13, 2020), Chapter 7, Medicine, Section 184.108.40.206, it states the following: “When billing for synchronous telemedicine services, providers will use CPT or HCPCS codes with a GT modifier for distant site and Q3014 for originating site to distinguish telemedicine services. In addition, Place of Service POS 02 is to be reported in conjunction with GT modifier. By coding and billing the GT modifier with a covered telemedicine procedure code, the distant site provider certifies that the beneficiary was present at an eligible originating site when the telemedicine service was furnished.”
TRICARE may or may not pay for the CPT codes commonly used by physical therapists, occupational therapists or speech-language pathologists that are found in the 92000 and 97000 series when billed with the GT modifier and Place of Service code 02.[/mepr-show]
Is preauthorization required for telehealth services?
If I have additional questions or I want to contact my TRICARE Regional Contractor, how can I do that?
TRICARE has 2 Regional Contractors. Health Net Federal Services is responsible for the West Region and Humana Military is responsible for the East Region.
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Has there been any announcement from Triwest regarding telehealth and PT/OT?
I just published an article.
Is it possible to get an example of how to bill?
Therapist is in the clinic. Patient is in their home. Used Zoom.
Codes 97110, 97112, 97116.
POS will be 02 and not 11
Will my billing line on the HCFA look like this?
03/26/2020 02 97110 GT
03/26/2020 02 97140 GT
03/26/2020 02 97116 GT
OR do i also add the Q3014 code with the GT modifier as an additional line?
Due to liability reasons, I am not giving examples on billing. I will say not to bill 97140 for telehealth.
Oh yea! Sorry – just tossing out codes! Thank you for all your information. This will be a trail and error in billing for awhile. I was also told by some insurances we will probably be denied even if claim si correct as their systems wont be updated correctly.
I agree with insurance companies not having their systems updated.
Does Tricare cover telehealth services provided in a skilled nursing facility?
My interpretation is no, but YOU must call TRICARE and ask.
Does Try care cover telehealth for Applied Behavior Analisis (ABA) services?
I know that cover code 97156, what about all other codes?
You would want to check with TRICARE.
I see that TriCare provides guidance on asynchronous communications – I would assume this means it will cover Telephone Services & Virtual Check-Ins?
Also, I assume we need to call to identify what CPT codes they are approving for telehealth since none are listed on their website?