When an in-person meeting is not ideal, telehealth can be a lifeline for behavioral health providers and their patients. Many behavioral health providers first became acquainted with telehealth during the COVID-19 pandemic.
Telehealth vs. Telemedicine
The term telemedicine is sometimes used interchangeably with telehealth. These terms overlap, but have different connotations. Telemedicine generally refers to services rendered by physicians (MDs). Telehealth refers to a broader range of services and can be rendered by a wider range of provider types.
Telehealth Billing Requirements
Billing for telehealth requires careful attention to the place of service (POS) and modifier codes. Many insurance companies allow telehealth, but at present there is no universal coding standard that applies for all carriers.
Place of Service (POS) Codes
Each line item on a claim requires a place of service (POS) code that indicates where the service was rendered.
- POS 11: In office
- Pos 02 or 10: Virtually (via phone or video chat)
During the pandemic, carriers regularly accepted POS 11 for telehealth visits. Carrier requirements have shifted over time for POS codes.
Modifier Codes
In most cases, telehealth must also be indicated by a modifier code. According to the AAPC,
A medical coding modifier is two characters (letters or numbers) appended to a CPT® or HCPCS Level II code. The modifier provides additional information about the medical procedure, service, or supply involved without changing the meaning of the code.
What Are Medical Coding Modifiers?
Modifier code 95 was introduced in January 2017 as a replacement for the older modifier code GT.
Some carriers accept both modifiers (95 and GT). However, we’ve found that major carriers overwhelmingly prefer modifier GT.
Carrier-specific Coding Requirements
The partial list of carrier-specific requirements below is current as of September 2022. We will endeavor to keep this list up-to-date if carrier requirements change. If you find that this information has gone out of date, please contact us!
- Aetna, Meritain Health: POS 02 or 10, modifier GT
- Providence: POS 10, no modifier
- Cigna, BCBS, Moda: POS 02, modifier GT
- Pacific Source: POS 11, modifier GT
- UHC (most), Optum, UMR, Sutter, UHSS: POS 02, modifier GT
- UHC Medicare Advantage plans: POS 10, no modifier