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, opens new window and state guidance, opens new window.

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, opens new window, state guidance, opens new window 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, opens new window, state guidance, opens new window 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, opens new window, state guidance, opens new window and Humana policy for additional information.