How does Humana handle claims with the new place of service (POS) code 10?

ANSWER: Humana accepts POS code 10 on claims for dates of service beginning January 1, 2022. Humana plans apply a telehealth benefit, when applicable, to claims reported with POS code 10.

Although Humana accepts POS code 10, we do not currently require it for reporting relevant telehealth services. Through the duration of the COVID-19 public health emergency (PHE), providers should report the POS code they would have reported had the service been done in-person and append either modifier 95 or FQ, as applicable, to indicate that the service was rendered virtually. However, Humana recognizes that some providers have continued to use a telehealth-specific POS code during the COVID-19 PHE. These providers are advised to use POS code 10 if the description of POS code 10 applies to the service being billed; they should not continue using POS code 02 if the revised description for POS code 02 is no longer accurate.

Please refer to Humana’s Telehealth and Other Virtual Services During the COVID-19 PHE claims payment policy for further information.

If a service is provided to someone registered as an outpatient of a hospital while that patient is in a location that is a temporary expansion location, should charges for services be billed with modifier PN or modifier PO?

ANSWER: Original Medicare permits hospitals to establish some locations, including a patient’s home, as temporary expansion locations. If a site has been established, according to Centers for Medicare & Medicaid Services (CMS) guidelines, as a temporary expansion location of a hospital, the hospital should submit charges for services provided, via telehealth, to a patient at that site with the modifier(s) that the hospital would use to submit charges for those services to Original Medicare.

When billing for timed services provided via telehealth, what can be accounted for in calculating time?

ANSWER: Consistent with CMS guidance, codes that describe medical discussion should only be submitted for services involving medical discussion; and the time used to select a specific timed code cannot account for administrative or other non-medical discussion with the patient.

Can rural health centers (RHCs) and federally qualified health centers (FQHCs) bill for telehealth and other virtual services?

ANSWER: Yes, RHCs and FQHCs can furnish and bill telehealth and other virtual services. Modifier 95 should be used to indicate the service was provided via telehealth. Modifier 95 is necessary to ensure appropriate cost-sharing determination. Each RHC and FQHC should continue to bill using the claim form (or electronic equivalent) it would have used before the PHE.

Are partial hospitalization and intensive outpatient services performed by telehealth billable services?

ANSWER: Yes, partial hospitalization and intensive outpatient services are temporarily billable as telehealth services during the COVID-19 public health emergency. Modifier 95 should be used to indicate the service was provided virtually. Please refer to applicable CMS guidance and state guidance.

Is group therapy conducted by telehealth a billable service?

ANSWER: Yes, CPT code 90853 is temporarily billable as a telehealth service during the COVID-19 public health emergency. Modifier 95 should be used to indicate the service was provided virtually according to Humana Policy. Please refer to applicable CMS guidance, state guidance and Humana policy for additional information.

Is psychological testing performed by telehealth a billable service?

ANSWER: Yes, CPT codes 96130-96133, 96136-96139 and 96121 are billable as telehealth services during the COVID-19 public health emergency. Modifier 95 should be used to indicate the service was provided virtually according to Humana policy. Please refer to applicable CMS guidance, state guidance and the Humana policy for additional information.

Are Applied Behavioral Analysis services performed by telehealth billable services?

ANSWER: Yes, when ABA services are covered by a plan, service codes 90889, H2012, H2019, H0031, H0032, 97151-97158, 0362T, and 0373T are billable as telehealth services. Modifier 95 should be used to indicate the service was provided virtually according to Humana policy. Please refer to applicable CMS guidance, state guidance and Humana policy for additional information.