New telehealth codes?

[nomaddamon]

Just looking for some clarity on a couple things, do these codes require modifiers like 95 or 93 based on how theyre written? And also , are they billable if the telehealth visit happens while the patient is in a hospital setting?

 

[The Flashhh]

Yep, those codes usually need a 95 modifier for telehealth. As for billing from a hospital setting, it depends, if you're not the admitting provider, you might still bill but check payer rules

 

[ch0c0chp]

Just looking for some clarity on a couple things, do these codes require modifiers like 95 or 93 based on how theyre written? And also , are they billable if the telehealth visit happens while the patient is in a hospital setting?

The 95 modifier is almost always required for synchronous (audio/video) telehealth visits to get paid, as it's the main way to indicate it was a virtual visit. The 93 modifier is specifically for audio only services, so you'd use that instead of 95 for a phone call

 

[mbcer218]

Just looking for some clarity on a couple things, do these codes require modifiers like 95 or 93 based on how theyre written? And also , are they billable if the telehealth visit happens while the patient is in a hospital setting?

I agree with @ch0c0chp, but just to expound on it.. the code themselves don't inherently require a 95 or 93 modifier based on how they're written. The need for a modifier depends on the service provided and the payer's specific rules. So yeah, the -95 modifier is used for services delivered via real-time audio-visual technology, and the -93 modifier is used for services delivered via audio-only communication. You'd apply these modifiers when the telehealth visit meets those criteria, not just because of the code itself.

As for billing when the patient is in a hospital, it's generally not billable.. Most payers, including Medicare, don't reimburse for telehealth services if the patient is in a facility like a hospital or SNF. It's always best to check with the specific payer for their rules.

Hope this helps clarify things!