Telehealth Modifier Codes
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What progress is SimplePractice making toward a functionality that will auto-populate telehealth modifier codes on claims?
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The Simple Practice instructions which were emailed with the notification that they created the modifier fields in the calendar pop up window explain that you enable this feature in settings. I followed the instructions and now the modifier fields appear:
You’ll be able to enable Modifiers by navigating to My Account > Billing and Services > Insurance > Modifiers. Once Modifiers are enabled, you’ll have two ways to add modifiers:
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Quickly add modifiers from the calendar by clicking a specific appointment.
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Set a default service code and modifier for a client on their Billing and Insurance Settings page so it applies to all of their appointments moving forward.
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Hi All - I can certainly clarify this for you.
The first step, as many of you have done, is enabling modifiers by going to My Account > Settings > Billing and Services > Insurance.Here are three ways you can add Telehealth modifiers to your service codes:
Option 1:You can add modifiers to an appointment from your Calendar.
- To do this, click on the Calendar and click on the appointment
- Add the modifier in one of the blank text boxes under the service
Here is a screenshot in my test account:
Option 2:You can also add a modifier from a client's Billing page.
- Go to the client's file, click the Billing tab
- Click on the bolded "Appointment" for the session you'd like to add a modifier for
- Add the modifier bellow the service code
Here is a screenshot in my test account:
Option 3:
You can also add a modifier to your client's default service code, to be applied to all sessions you schedule with them in the future.
- To do this, go to the client's file, click Edit under the client's name, click on the Billing and Insurance tab
- Now scroll to the very bottom of the page and add a default service under Client Default Services
- Add a modifier to this service
Here is a screenshot:
Note: Adding a modifier to a client's Default Service won't change any previously scheduled appointments. Use one of the other two methods to retroactively add a modifier.
Lastly, you can manually add a modifier to a claim that's already been created, before you submit it to the insurance payer.
For more information on the various ways you can add a modifier, please check out our guide: How do I add modifiers to my claims? -
Hi Elizabeth - Yes, you'll want to delete the previously generated billing documents (Invoice and Superbill), prior to changing the service codes from your clients' Billing page, or their appointments on the Calendar. Next, you'll want to regenerate these billing documents to contain the updated service codes.
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Is there a way to associate modifier with place of service? For all telehealth I will need modifiers, it would be easiest if it were associated with location in regard to telehealth. For those clients that do telehealth sometimes, in person others, I don't need the modifier on each cpt code, only need them for telehealth. If I change the default service to be 90834 with modifiers then I have to remember to change it when I see them in person. Is there a way to have service codes specific to place of service?
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Hi Katherine and Alycia, I'd be happy to help. Be sure to enable Modifiers in your account under My Account > Settings > Billing and Services > Insurance. That will allow you to associate Modifiers with the Services you offer in SimplePractice.
Elizabeth, currently, there is not a way to have service codes specific to place of service - instead, modifiers are set at the client level under Edit Details > Billing and Insurance in the Client Default Services section.
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I believe moving forward it would be very helpful to set modifiers at the service level and not the client level. It doesn't make sense for those clients who are receiving multiple services. It would be much easier if I could create a telehealth service code with a modifier attached. And for that matter an Equine service code, which is code 99 for at an other location) the service dictates the need for the code, not the client.
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Hi Bridget, thanks for the feedback! Please add this feature request to our Ideas and Suggestions Board, here: http://simplepractice.uservoice.com/ !
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I agree that we REALLY NEED to have where the telehealth is automatically added to a claim if the service location is "telehealth office". This is going to be a BIG deal here in the next 1-2 months, where more offices (including mine) will be allow some in-person session, where a client will likely be going in-between telehealth and in-person. I have 3 employees that will need to remember when to put in a modifier... which significantly increases the chances that the claim will be either denied OR billed incorrectly. Please update this. I put in my other request that what really needs to happen is that simple practice allow multiple service codes of the same service. For example 90853 - CASH Rate. But also allowing 90853 - Telehealth. And even better to help me save time (with multiple contracted rates) would be allowing something like 90853 - Aetna Rate and 90853 - Blue Cross Rate. Seems like allowing multiple types of the same service code would be the easiest way to program and solve everyone's issue with this. Each service code can then be selected by the therapist and billed correctly (such as each service code would allow a modifier if needed OR the correct charge for each contracted rate with insurance is allowed). My other billing company I was using allowed this and everything billed out smoothly.
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SIMPLE PRACTICE! WHY IS THIS STILL NOT DONE! All of our claims are being submitted incorrectly. If the clients claim is set to 02 telehealth than it should be going out with the 95 modifier. I cant set the clients default code to go out with the modifier because sometimes they are seen in person. You need to give me the option to add a default modifier within the service codes. Like come on. It is incredibly time consuming to enter 95 into each and every claim since you have to do it from calendar, you cant even do it from the billing screen. If we get audited Ill be sure to send them your way.
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