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Claims overview

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Claims for covered telehealth services provided at the distant site should be submitted using the applicable CPT or HCPCS code. Using the telehealth Place of Service (POS) code 02 indicates that the services were provided via telehealth and meet the telehealth requirements. Medicare payment is based on the PFS for telehealth services. 
 
Since using POS code 02 certifies that the services provided meet telehealth requirements, modifier 95 (synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system) is not applicable for Medicare telemedicine services. However, it may be required by other payers.  
 
For eligible providers who have reassigned billing rights to a CAH that elected the Optional Payment Method, the CAH may bill for telehealth services on an institutional claim using the GT modifier (via interactive audio and video telecommunications systems). The payment amount is 80% of the Medicare PFS for telehealth services. 
 
Federal telemedicine demonstration programs in Alaska and Hawaii are directed to submit claims using the appropriate CPT or HCPCS code with modifier GQ (via an asynchronous telecommunications system) appended.  
 
Medicare Administrative Contractors (MACs) have been directed by CMS to apply frequency edit logic to telehealth codes billed with POS code 02 for claims with dates of service Jan. 1, 2018, and after. The “one every 30 days” frequency edit logic applies when subsequent nursing facility care codes are billed with POS code 02 and the “one every three days” frequency edit logic applies when subsequent hospital care codes are billed with POS code 02.