PPS and IO: Telehealth Billing
This article applies to the Private Practice Suite and Valant IO
Valant supports the billing of telehealth claims. Payers have different requirements to successfully bill telehealth claims and practices should always verify requirements with the payers before billing. Many payers will require the Place of Service (POS) of 02 for Telehealth, and/or modifiers be added to the claim. Some payers will require a specific CPT code for telehealth services.
- The Place of Service (POS) code for Telehealth is 02. Users can add POS 02 and name it Telehealth or Telemedicine by going to Reference Data | Places of Service | New Place of Service.
- Note: Medicare is recommending to not put 02 as the POS on claims effective 3/1/2020. They are still requesting the modifier 95 on claims. The reasoning is that the POS 02 results in a lower payment because the assumption is that the patient is in another facility. Since the patient is presumed to be at home, the costs are being born by the telehealth provider. Commercial payers often follow Medicare, but It is best to always verify with the payer before billing.
- One suggested workflow is to add new procedure codes with POS 02 that mirror current codes, but have a different Transaction Code ID to differentiate them from standard procedure codes. For example, 90834Tele in the Transaction Code ID, and 90834 in the CPT field. The Transaction Code ID is unique to Valant and does not appear on a claim. This can be done by navigating to the "Procedure Code page in Transaction Codes | Procedures. Use the "Description Field" to specify the code is a telehealth service since the description will be visible to the providers and staff when creating the appointment on the scheduler. On the procedure set the "Places of Service" to the telehealth place of service. This will ensure "POS 02" is sent out in the claim file. Please Note: Modifiers for Telehealth visits required by some payers are entered elsewhere in Valant, and should not be included in the CPT code field (See Fee Schedules below).
- Another workflow which Valant recommends is the use of individual Payer Fee Schedules to automatically associate modifiers with services. These can be updated to show telehealth codes and be used to create Telehealth claims.
Note: Both of the above workflows will only apply POS and modifier codes to new appointments,and will not update existing charges or appointments already on the calendar.