Telehealth FAQ's

Thank you, Chris, for this opportunity. I've been working with clinical staff today gearing up for telehealth services -  who can and cannot bill, how to bill and to identify those clients where we would implement those services. 

What I've discovered is telehealth services are plan specific for commercial plans therefore it's best to call the health plan directly to ask if this service is a covered benefit. 

With regard to MA/PMAP plans, the GT modifier is no longer required, but we must use the 02 code for the Place of Service (POS). For Outpatient Mental Health services, normal routine CPT codes are allowed in combination with the 02 POS for billing. 

I'm still learning more as I continue to make phone calls in the coming days. 

I can tell you, last I knew, BCBS was requiring the GT modifier.  Had a few denied for missing it.

Thank you for input Chris and John.  I am also trying to figure out what to do as far as telemedicine.  My question is do we need to get each provider credentialed to provide telemedicine services (licensed and MHPs).  This process could take weeks and at this time, we dont have that amount of time especially for clients who are in need of services.  Any thoughts?

Hi Rochelle,

My findings are for INW/fully credentialed licensed people. Call the specific health plan for each client and ask how they view your question. They may allow it with prior authorization. I just don't know. It's uncharted territory for many. We will learn together. 

Good luck.

Debbie Trunk

You don't need any special licensing to provide telehealth services.  Practitioners still bill under the billing supervisor.  Anyone who is fully licensed will need to sign an "assurance statement for telemedicine" for MA, maybe some others.  Located right here:  https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6806-ENG

Cigna has their own form that you have to get completed and signed by each licensed staff. They are not requiring all be turned in prior to billing 02 POS, as they understand the circumstances. UCare is requiring the same form DHS does (6806) for each licensed staff, as well. We have been calling each individual provider to find out which modifier (some have been GT, some 95 and some just the POS 2 is good enough) to bill with, and which staff may bill. PreferredOne said they are only allowing licensed staff to provided telehealth services, but might be changing that to allow supervised staff. If they do change their position, it will be in their provider updates (newsletter/bulletin) section of their provider site. I don't know if any of this information is contractual to our agency, or if this is general information we have received from the payers but am willing to share anything at this point - to get clients seen. 

Thank you for posting this feed, so we can all share what we have learned and help as many of our clients as possible!

Greetings to Sararh and the rest of the group interested in telehealth/telepschology/telecounseling. You have to do your due diligence - as others have described. In my experience, once you get the structure in place - including your internal documents (informed consent for telehealth, patient selection and safety policies) you it gets a lot easier - but you still need to develop a workflow for telehealth that is in someways different that in-person app'ts.  All of this is covered in my one hour, info- packed CE video. 

Is there anyone who provides Children's Mental Health Targeted Case Management? How are you going to move forward with seeing client? Is anyone considering Telemed options for TCM?

Thanks 

Here are some additional resources that may be useful if you're looking for more info:

https://www.cchpca.org/sites/default/files/2019-10/50%20State%20Telehalth%20Laws%20and%20Reibmursement%20Policies%20Report%20Fall%202019%20FINAL.pdf

https://gptrac.org/

And on Thursday, Great Plains Regional Center is having a special webinar regarding Telehealth and COVID-19.

Thank you all for your questions and knowledge!

Hi there, my question is regarding the kiosk system to get Telehealth forms signed via email. I'm having trouble converting our forms into "client-type" forms, the forms required to be able to kiosk them to clients via email on Procentive, and I'm at a loss for what to do on that end. Has any other clinic had experience with kiosking in the past and know what steps to take to get this up and running, particularly with the "client-type" form conversion? The webinars on the Procentive website are helpful, but I'm not finding that bit of info.

Is anyone aware if  90791 Diagnostic Assessments or H0001 Rule 25 Assessments are allowed via Telehealth?

I believe I heard in a webinar yesterday that Medicare just lifted their ban on TeleTherapy services. We aren't credentialed with them, but for those of you who are, maybe this will be helpful.

Do we want to share knowledge about individual payers' requirements? It might help us avoid all recreating the same work. 

So far, what I'm hearing is that BCBS MN, Cigna, HP, UBH/Medica/Optum, Pref One all will cover tele therapy in general, but since plans can all be different, we need to check each one to verify whether it is covered. Does anyone know of an easier way to do this? The phone lines are bad enough as it is, and if all of us are calling for every client, it will be impossible... 

Has anyone billed medicare for telemedicine and if you did can you tell what modifier was used if any.

Thanks

My understanding is that Medicare is no longer requiring the GT or 95 modifier. Just have to make sure that the Place of Service is Telehealth (2).

This is what I found:

For over a decade, Medicare has required providers to append special modifiers to their CPT and HCPCS codes when billing for telehealth services. ... Effective January 1, 2018 that has changed because CMS has decided to largely eliminate the requirement to use the GT modifier on telehealth claims.

Hope this helps!

Anissa

Thank you for that information. 

Thank you everyone for the valuable information.

Chris, do you know if the modifiers GT and 95 will be added to payers?

thanks

Here are a couple of informational articles regarding Medicare-Telehealth and Opioids-Telehealth.

Hopefully these can help you out!

https://www.natlawreview.com/article/exemptions-and-considerations-treatment-opioid-use-disorder-during-covid-19

https://www.natlawreview.com/article/covid-19-cms-issues-monumental-changes-to-medicare-telehealth-what-you-need-to-know

Stay healthy!!

Thought I'd share my experience regarding UBH/Medica/Optum and billing telehealth. My first claims came back rejected/denied, not covered. According to the UBH/Medica/Optum rep, they only want the POS to be 02, NO GT modifier. I was told to send replacement claims after removing the GT modifier. Hope this helps!

My question now is do I need to create an entire new set of telehealth codes without the GT modifier in the Codes Module? BCBS said they still want the GT modifier...

Thank you!  That was great information!

We have found the following to not need the modifier: HealthPartners, HealthPartners PMAP, MA, Optum (UBH/Medica), SCHA - if that helps. PreferredOne and Cigna use the 95 modifier, as opposed to the GT.

Sarah, so I assume then that you do have two different sets of codes, one with GT and one without? Thanks!

Sarah, thank you.  We had received something from Medicaid (MN MA) that they wanted us to use the GQ modifier.  So far we've been ok using that.

Yes. But we have all of our codes entered into the payers by program, so only the required modifier is available to staff when billing.

We setup 3 and labeled the insurance so the clinician knows which one to use for each client.

So far this has worked well,also you can set the place of service on the billing tab of the code so it automatically defaults and saves you time from resubmissions

Hey All,

Here is a link for eligible providers to apply for Federal assistance with Telecommunication services.

https://www.fcc.gov/covid-19-telehealth-program

Please check it out.  Hope this helps some of you!

Do you know what type of clinics are eligible for this program?  

Hi Tammy,

This is what I was able to find:

Here's the latest info we've seen from DHS: