Commonwealth Care Alliance has updated the Telemedicine-Telehealth payment policy and the billing and coding guidelines for services provided via telemedicine/telehealth (e.g., interactive audio-video, interactive audio only).
Reminder: Accurately document both the
- Place of Service (POS) code and
- appropriate modifier.
Aligned with the Centers for Medicare & Medicaid Services (CMS) current descriptions, the CCA Place of Service (POS) code attests to the accurate location of the member during the provided service.
| Place of Service Code | Place of Service Name | Place of Service Description | Examples of the Patient’s Location |
|---|---|---|---|
| 02 | Telehealth Provided Other Than in a Patient’s Home | The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health-related services through telecommunication technology. | Hospital Medical Facility Medical Office |
| 10 | Telehealth Provided in Patient’s Home | The location where health services and health related services are provided or received, through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology. | Patient’s Home Patient’s Car Private, Non-medical Location |
Available modifiers include:
| Modifier | Description |
|---|---|
| 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system |
| GT | Via audio & video telecommunications systems |
| G0 | Telehealth services for diagnosis or treatment of symptoms of an acute stroke |
| GQ | Via asynchronous telemedicine |
| FQ | Service furnished using audio-only communication technology |
For additional information, review the Telemedicine-Telehealth Payment Policy
- Massachusetts: Payment Policies
- Rhode Island: Payment Policies
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