Billing and coding Medicare Fee-for-Service claims
Read the latest guidance on billing and coding Medicare Fee-for-Service (FFS) telehealth claims.
Eligible telehealth services
There are currently more than 250 codes on the Medicare telehealth services list that are eligible for reimbursement. Additions and deletions of codes on the Medicare telehealth services list generally occurs on an annual basis. For the latest information, view the list of telehealth services.
Coding claims
It is important to make sure you accurately bill for telehealth services. While there are many similarities in billing for in-person and telehealth services, there are some important differences. This includes:
- Audio-only: Interactive telecommunications system may permanently include two-way, real-time audio-only communication technology for any telehealth service furnished to a patient in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system, but the patient is not capable of, or does not consent to, the use of video technology. You are required to use the following modifiers when billing for these services: CPT modifier “93” and/or Medicare modifier “FQ” for Federally Qualified Health Centers and Rural Health Clinics.
- Place of Service codes: When billing telehealth claims, it is important to understand the place of service (POS) codes as it affects reimbursement. POS 02 refers to telehealth provided other than in patient's home and POS 10 refers to telehealth provided in patient's home.
Common telehealth billing mistakes
Avoiding mistakes in telehealth billing can help streamline processes. Here are some key considerations:
- Billing codes. There are more than 250 telehealth services covered under Medicare. Using the wrong code can delay your reimbursement. This can happen for a variety of reasons, such as a misunderstanding of what code applies to what service or input error. Stay up to date on the list of telehealth services to keep your practice running smoothly.
- Modality. It is important to make sure that you are using an allowable modality for the telehealth service you are delivering. If you are required to use a modifier, make sure to include it on the claim.
- Location. You need to understand eligible originating and distant sites in Medicare to ensure that you are providing and your patients are receiving services from allowable sites and geographic locations.
- Documentation. Post-visit documentation must be as thorough as possible to ensure prompt reimbursement. There are many similarities between documenting in-person visits and telehealth visits.
More information:
Medicare payment policies — Health Resources and Services Administration
Telehealth policy updates — Health Resources and Services Administration
List of telehealth services — Centers for Medicare & Medicaid Services
Understanding telehealth policy — National Policy Telehealth Resource Center
Billing for Telehealth Encounters: An Introductory Guide on Fee-for-Service (PDF) — National Policy Telehealth Resource Center