[The following applies for certain to Tricare West, and may or may not apply to other Tricare programs such as Tricare East.]
Tricare now requires billing of Tele-Health Place-of-Service to be from where the CLINICIAN performs the service if you would have seen them in-person - until the COVID emergency declaration ends.
If you are performing a telehealth session at your office or home-office, use the "11-Office" POS with a modifier in the 1st box of "95" or "GT" (all mental health codes can be either and since TriWest also requires an 11/95 for mental health telehealth services it may be easier to use that.)
This does mean that all Telehealth claims will need to be modified real quick (pick the POS 11) because it's defaulted to an "02-Telehealth" in the claim (unless you default your telehealth office to "11" which is easiest and then no modification is needed!)
An "11" will pay about 10% more than an "02."
Don't forget that modifiers can be set to populate automatically in new appointments using the "Client Default Services" at the bottom of their "Billing and Insurance" page and also can be entered into the little boxes below the service line in any added appointment.
Please sign in to leave a comment.