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Tricare updates Tele-Health billing procedures

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7 comments

  • Ruth

    Hi Edna, you can change the Insurance Place of Service for your Telehealth Office Location by going to Settings > My Practice > Edit and use the dropdown menu to pick 11-Office. 

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  • Mei Hua-Burns

    Does Tricare East also take this 11/95? Can you post a link to where Tricare announced this change? I can't find it anywhere. 

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  • Wendy Belding

    Hi,

    Tricare East uses Humana.  Here's a page [ https://www.humanamilitary.com/provider/education-and-resources/quick-access/telemedicine ] that leads to this document: [ https://docushare-web.apps.cf.humana.com/Marketing/docushare-app?file=3924427 ].

    How do I bill for telemedicine services?

    Please refer provider to policy for applicable CPT codes.

    Synchronous* telemedicine services will use CPT or HCPCS codes with a GT modifier for distant site and Q3014 for an applicable originating site to distinguish telemedicine services. Also, Place of Service “POS 02” is to be reported in conjunction with the GT modifier.

    Asynchronous* telemedicine services will use CPT or HCPCS codes with a GQ modifier.

    When submitting claims for telemedicine services, the provider may indicate “Signature not required-distance telemedicine site” in the required patient signature field.

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  • Mei Hua-Burns

    Hi Wendy, both of the documents you posted reference Place of Service “POS 02” when billing Telehealth. I do not see anywhere that says we can use "11-Office" POS as stated in your original post.

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  • Wendy Belding

    Hi Mei,

    That original statement is for what I use, which is Tricare West.  I don't use Tricare East, but was merely pointing you in the right direction to bill appropriately.  I should have put Tricare West in the original post.  Sorry.

    However, I did just find this: https://manuals.health.mil/pages/DisplayManualHtmlFile/2021-03-26/AsOf/tp15/c7s22_1.html

    • 2.3.2.4  For billing asynchronous telemedicine services, providers will use CPT or HCPCS codes with a GQ modifier. In addition, POS 02 is to be reported in conjunction with the GQ modifier. Place of Service Code 02 is not required for telehealth claims if a more appropriate Place of Service Code is necessary for correct billing.
    This does not mean the Humana can/will process it this way.  The original above of 11/95 was how Tricare West got us "correct" billing (full reimbursement rate instead of reduced telehealth reimbursement rate).  Humana may be getting you full reimbursement rate already. 
     
    The reimbursements right now (may adjust slightly for service area, etc. - if you're not off by at least 10%-12% it's probably not a POS/Modifier billing issue) are:
    90837 - $119.61
    99354 - $102.09
    90791 - $142.22
     
     
    If your reimbursements are significantly lower than this, I'd try one claim at 11/95, and another one at 11/GT and see if they even process at all, and - if so - what they pay.  If it's higher, to get the higher rate on all old claims you would have to resubmit them with the new POS/Modifier combo (which is actually very easy to do in S/P - it takes 30 seconds).
     
    Best of luck!
     
    The same info is also on a COVID-specific release [TRICARE Coverage and Payment for Certain Services in Response to the Coronavirus 2019 (COVID-19) Pandemic] for temporary exception to the prohibition on telephone services in the United States with an effective date of May 12, 2020:
    • 2.1.3  Other authorized telephone services (e.g., psychotherapy services) shall be reported with the appropriate CPT or HCPCS code and with the appropriate modifier or place of service code (e.g., 02) to report that the care was delivered via telephone. Place of Service Code 02 is not required for telehealth claims if a more appropriate Place of Service Code is necessary for correct billing.
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  • Mei Hua-Burns

    Hi Wendy, thank you very much for that explanation. It is very helpful.

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  • Edna Cydne Collins

    Bills with the 02 site code are being rejected.  How can I insure the 011 code is on the billing forms without editing each form?

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