Due to the COVID-19 pandemic, many providers of outpatient therapy services are implementing telehealth services to meet the needs of their patients. Since many have never provided telehealth services previously, they are uncertain how to do the billing. In addition, insurance carriers who are expanding telehealth coverage, either voluntarily or state mandated, may not have guidance for providers regarding the billing of outpatient therapy telehealth services. In this article, I will provide answers and/or guidance on some of the questions I have been receiving.
Does the Medicare program pay for telehealth services provided by a physical therapist, occupational therapist or speech-language pathologist for outpatient physical, occupational and speech therapy services?
Answer – Updated March 31, 2020
Question – Added March 31, 2020
Did the Centers for Medicare and Medicaid Services add any of the commonly billed CPT codes by physical therapists, occupational therapists and speech-language pathologists to the list of covered telehealth services?
Question – Added March 31, 2020
Who currently can bill the newly added CPT codes for telehealth services to the Medicare program?
What CPT code(s) do I use when billing for outpatient therapy telehealth services?
Can hospital outpatient therapy departments bill insurance carriers for telehealth services?
Question – Added April 1, 2020
For hospital outpatient therapy departments and getting paid for telehealth services, could it make a difference with an insurance carrier whether they submit claims on a 1500-claim form or a UB-04 claim form?
Question – Added April 1, 2020
For outpatient rehabilitation facilities (Rehabilitation Agency) and getting paid for telehealth services, could it make a difference with an insurance carrier whether they submit claims on a 1500-claim form or a UB-04 claim form?
On the 1500-claim form, what place of service code do I use when providing telehealth services?
On the UB-04-claim form, what place of service code do I use when providing telehealth services?
Are there any other modifiers that we would need to use on the claim form if providing telehealth services?
If telehealth is allowed by an insurance carrier, can a physical therapist assistant and occupational therapy assistant provide telehealth services?
What is the difference between asynchronous and synchronous communication?
I see many insurance carriers state they will pay for synchronous telehealth services for CPT codes list in Appendix P of the CPT book. What are the CPT codes listed in Appendix P?
I hope you found the questions and answers to be helpful. If you have additional questions, please email them to me and I will post the answers as applicable and appropriate. Keep in mind answers may change as CMS and other insurance carriers update their policies.
Thank you for being a Gold Member!
All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.
This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.
I’ve seen and read a lot of information about the expanded Telehealth coverage and how to bill for it, but the issue of the 1135 Waiver continues to come up. Can you explain how a small-town, outpatient therapy department, gets one? I have the information from CMS (toolboxes & checklists) but I can’t seem to get a handle on whether we need an individual waiver or if Georgia is covered under a blanket waiver. Or is the nation covered under a blanket waiver?
We are a hospital based (read facility billing) outpt PT/OT clinic. Can we bill for Telemed and/or evisits? I am hearing that we may not be able.
You will need to check with each insurance carrier regarding telehealth coverage.
What is the difference between modifier GT and 95. Is one used on UB-04 and one for 1500
They both mean telehealth was provided via a synchronous communication. You would have to check with each insurance carrier what modifiers are required.
To expand on the question above, also a hospital based outpatient facility so billing on a UB-04 and understand that there is not a place to indicate POS. Most of our insurances are now covering telehealth and some require a GT modifier; just verifying per your statement above, that 02 modifier is not required on the UB-04? Thank you.
Place of Service codes are only used on the UB-04 claim form.
Can you please clarify when to use 02 place of service vs 11 place of service for a physician-owned outpatient PT clinic doing Telehealth?
For Medicare patients, specifically**
What is your exact question?
If providing a PT telehealth visit incident-to a physician, place of service code would be 02.
So can PT’s still bill the G2 codes to Medicare that they released at the beginning of all this? Or can PT’s not bill Medicaid period for Telehealth services?
You mention both Medicare and Medicaid in your questions so I’m not sure what yo are asking.
Outpatient hospital billing as facility can or cannot bill telehealth PT/OT to Medicare?
Right now, no one can get paid for telehealth under Medicare Part B for outpatient therapy services. Exception is a PT or OT employed by a physician and billing incident-to the physician.
TDI is following CMS guidelines for telerehab, which still excludes PT’s/OT’s from billing the allowed 97000 codes. I assume this would be for those companies that are subscribers to work comp in TX. Are non-subscribers allowed to reimburse for these services if provided by PT’s/OT’s? I assume these are reimbursement restrictions and not TX practice act restrictions for tele-rehab.
My department serves inpatients in a medical center, which includes observation patients who would be billed for our services under Medicare Part B. We have just begun to provide evaluation and treatment through Telehealth to both types of patients in our setting who are either under investigation or Covid-positive to limit exposure, use of PPE, and possibility of becoming a vector of the virus. My question is: if we charge the normal CPT codes for evaluation and treatment would Medicare consider this fraudulent billing even though we are clearly stating in our documentation that the visits are via telehealth? I understand that the charges currently will be denied by Medicare but the charges give us a way of accounting for our time.
This is nt a question I can answer. I would recommend you discuss this with your risk management and legal department.
Can you explain if asynchronous telehealth has to include a video component or could it solely entail communication via email of home exercise programs and functional assessment tools via an online patient portal ?
Due to liability reasons, not a question I can address in this format.
For a UB form would the Rev code need to be changed to the 780 or would just using the GT or 95 modifiers be enough
You would need to check with each insurance carrier as to do they pay for telehealth services submitted on a UB-04 claim and if yes, what revenue code do they want you to use.
Since traditional Medicare is still not acknowledging OT’s/PT’s to perform Telehealth, I just wanted to clarify about the Medicare Advantage Plans. For example: UHC is covering OT/PT for Commercial and Medicare ADV plans from 03/31 to 06/18/20. Would this override CMS guidelines & they (UHC Med Adv) would pay Telehealth for an OT or PT? I understand each plan is different but wanted to see if this accurate.
Read my latest article at https://gawendaseminars.com/medicare-advantage-and-telehealth-services/
When billing with a 95 modifier–does it matter whether you bill GO 95 or 95 GO on the 1500 form? Thank you.
The order should not matter. Keep in mind that as of today at 8:30AM PDT, the Medicare program does not pay for telehealth if provided by a PT, OT or SLP.