COVID 19 Medicare PPS Billing TeleHealth Services with athenaPractice TM
This is a Step-by-Step Guide on how to set up the appropriate features in athenaPractice to facilitate Medicare PPS TeleHealth billing.
Medicare PPS - Billing Telehealth Services
The below settings are needed for FQHC/RHCs that will continue to bill at their all-inclusive rate and will be paid based on their FQHC/RHC Prospective Payment System (PPS) rate. As referenced in MLN Matters SE20016, these claims will be automatically reprocessed in July when the Medicare claims processing system is updated with the new payment rate. It is our recommendation that customers continue to bill claims as they were prior to January 27, 2020, apart from making sure to include the appropriate TeleHealth modifiers. FQHC/RHCs do not need to resubmit these claims for the payment adjustment.
Practice Management Setup
Log into the Centricity and open the Administration Module
Administrative Setup
Loading CPT Code G2025 in advance of 7/1/2020
Codes > Billing System > Load HCPCS and CPT Codes
- CPT Code
- Department
- Procedure Code Qualifier (assign appropriate qualifier based on service)
- Assign Specialty
Creating Modifiers
Codes > Billing System > Modifiers
- Description (include modifier in the description)
- NSF Code (enter modifier only)
Telehealth Modifiers
- 95 - Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system
- CS - Modifier CS should ONLY be applied to any services related to COVID-19 testing, including applicable telehealth services, for services furnished beginning on March 1, 2020.
Insurance Carrier Approval Settings
Insurance > Insurance Carriers > Medicare PPS > EDI > Edit File Creator Row > Claims > Creator Plug-In > Settings
- Check Box “Send CPT Code in Loop 2400 SV2 Segment”
Note: This setting may already be in place, as it is needed when sending modifiers.
Note: Please refer to the ‘TeleHealth Setup for athenaPractice’ document for additional administrative setup.
Billing Claim Examples
FQHC TeleHealth Audio and Visual
FQHC can continue to bill at their all-inclusive rate.
Telehealth services - Visits conducted between a provider and a patient using two-way telecommunication systems with audio and video capabilities.
- Use of two-way, real-time interactive audio/video telecommunication capability is needed.
- Bill appropriate covered telehealth service code(s), as you would your normal face to face visit
- Modifier 95 should be applied to claim lines for services furnished via telehealth
- Modifier CS should ONLY be applied to any services related to COVID-19 testing, including applicable telehealth services, for services furnished beginning on March 1, 2020.
Example Claims for Audio and Visual Services starting July 1, 2020
- Modifier 95 is optional and is not needed for services after 6/30/2020.
- Modifier CS should ONLY be applied to any services related to COVID-19 testing, including applicable telehealth services, for services furnished beginning on March 1, 2020.
RHC TeleHealth Audio and Visual
RHCs can continue to bill at their all-inclusive rate.
Telehealth services - Visits conducted between a provider and a patient using two-way telecommunication systems with audio and video capabilities.
- Use of two-way, real-time interactive audio/video telecommunication capability is needed.
- Bill appropriate covered telehealth service code(s), as you would your normal face to face visit.
- Modifier CG should be applied to claim lines.
- Modifier 95 is optional for services furnished via telehealth.
- Modifier CS should ONLY be applied to any services related to COVID-19 testing, including applicable telehealth services, for services furnished beginning on March 1, 2020.
Example Claims for Audio and Visual Services starting July 1, 2020
- Modifier CG and 95 is not needed for services after 6/30/202
- Modifier CS should ONLY be applied to any services related to COVID-19 testing, including applicable telehealth services, for services furnished beginning on March 1, 2020.
FQHC/RHC TeleHealth Audio only
Virtual check-ins - Brief (5-10 minutes) check-ins with a provider via telephone or other telecommunications device to decide whether an office visit or other service is needed. May include remote evaluation of recorded video and/or images submitted by an established patient.
- Bill G0071 with Revenue Code 0521 for UB claims
- No modifier is required. If these services are submitted with modifier 95, the claim may deny.
Example Claim for Virtual check-ins Services as of January 27, 2020
FQHC/RHC Telephone-only services
When furnishing services via telehealth that are not FQHC qualifying visits, FQHCs should hold these claims until July 1, 2020
Telephone-only - Non-face-to-face E&M services provided using telephone audio only. Medicare is suggesting holding any telephone only visits until July 1, 2020 and billed with the G2025, see SE20016 for details.
Current Procedural Terminology codes include:
- Bill G2025 with Revenue Code 0521 for UB claims
- No modifier is required. If these services are submitted with modifier 95, the claim may deny
Example Claim for Telephone-only Services as of January 27, 2020 (HOLD claims until 7/1/2020)
Note:
- Please be sure to stay up to date on the Covered Telehealth Services for PHE for the COVID-19 pandemic via gov, as this list is continually updated.
- This document will be updated as the July 1st date approaches, to reflect any updates needed for claim filing.
- This document is also subject to change as CMS continues to provide updates.