1. “I don’t know the CPT code for video/phone sessions.”  Sure you do.  You just use the same CPT code (ex. 90834, 90837, 90847) that you would have used if the session took place in person.  Yes, even for phone therapy.

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2. “The Place of Service (POS) code, usually 11 to indicate the session took place in my office, should be 02 for telehealth, right?”  Well, this is a safe bet,  though some plans (notably Medicare) want you to keep using 11.  One regional plan I know wants you to use 98.  So, be sure you read down to #10 below for help.

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3. “My colleague told me for all video or phone sessions to add a modifier 95 after the CPT code.”  Not necessarily. It may be the best bet, but some plans want the older modifier GT (most notably, perhaps, Optum/UBH), some plans will accept either one, and some don’t need one. Again, be sure you read down to #10 below for help.

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4. “If I put the Place of Service Code, I don’t need the modifier (or vice versa).”  No, it’s usually best to put both, unless told otherwise by the plan.

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5. “I know the modifier and Place of Service code for video, but it’s different for phone sessions, right?” Typically not. The 02 Place of Service code refers to any telehealth.  Both GT and 95 both refer to any “synchronous telemedicine.”

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6. “I need to use a HIPAA-compliant telehealth platform for my sessions.” While this is recommended, the federal government has waived enforcement of HIPAA regulations during this health emergency, stating that health care providers could use popular applications such as FaceTime or Skype, without risking that the government might impose a penalty (see complete article here).

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7. “Since the health plan covers video, phone sessions will be covered.” During the pandemic it does seem that most insurance plans are covering phone sessions, but assume nothing.

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8. “I’m not a network provider, but the plan will cover my telehealth sessions.”   This may be true, but some plans cover telehealth sessions only when provided by network providers, or only cover out of network providers doing telehealth with clients who were seeing them before the pandemic began.

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9. “Health plans are waiving client copayments for telehealth during the pandemic, so I shouldn’t collect them.”  This is true for many plans — the plan will pay your full contracted fee without taking out the client’s copay.  But not all client copays are waived — verify with the plan.  I would bill as soon as possible to see how claims are processed.  Also, keep track of the start and end dates of their copay waiving period. And remember that waiving copays may not apply to in person sessions, if you are doing them.

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10. “You tell me not to make assumptions, but I can’t get through to health plans, so there’s no way for me to know what each health plan wants in terms of billing codes and coverage!”  Not true!  In case you missed it, I have put together a free resource that lists telehealth billing policies for many health care plans around the country, listing (when possible) the Place of Service codes and modifiers they want.  I update it regularly (you can help!)  That resource is at www.theinsurancemaze.com/telehealthpolicies.

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