Telehealth can be a lifeline for behavioral health providers and their patients when an in-person meeting is not ideal. Many behavioral health providers first became acquainted with it during the COVID-19 pandemic.
Telehealth vs. Telemedicine
The terms telemedicine and telehealth are sometimes used interchangeably. These terms overlap, but have different connotations. Telemedicine generally refers to services rendered by physicians (MDs). Telehealth refers to a broader range of services and can be rendered by a wider range of provider types.
Telehealth Billing Requirements
Place of service (POS) and modifier codes require special attention when billing for telehealth. At present there is no universal coding standard that applies for all carriers.
Place of Service (POS) Codes
Place of service (POS) codes indicate where a service was rendered. Each line item on a claim requires a POS code.
- POS 11: In office
- Pos 02 or 10: Virtually (via phone or video chat)
Insurance companies regularly accepted POS 11 for telehealth visits during the pandemic, but their POS coding requirements have shifted over time.
Modifier Codes
Most insurance companies require a modifier code to indicate telehealth. When the carrier requires a modifier code, use it on every line item.
According to the AAPC,
A medical coding modifier is two characters (letters or numbers) appended to a CPT® or HCPCS Level II code. The modifier provides additional information about the medical procedure, service, or supply involved without changing the meaning of the code.
What Are Medical Coding Modifiers?
In January 2017, the AMA announced that telehealth modifier code GT was replaced by modifier code 95. However, major carriers have not fully adopted modifier 95.
Some carriers accept both modifiers (95 and GT); but, in our experience, they overwhelmingly prefer GT.
Carrier-specific Coding Requirements
We’ve compiled a partial list of carrier-specific requirements below. This list is current as of September 2022. We’d like to keep this list up-to-date, so if you find that this information has gone stale, please contact us via the form on our homepage!
- Aetna, Meritain Health: POS 02 or 10, modifier GT
- Providence: POS 10, no modifier
- Cigna, BCBS, Moda: POS 02, modifier GT
- Pacific Source: POS 11, modifier GT
- UHC (most), Optum, UMR, Sutter, UHSS: POS 02, modifier GT
- UHC Medicare Advantage plans: POS 10, no modifier