MassHealth has released MCE Bulletin 95, which includes updated telehealth policy requirements and new billing guidelines that (1) amends and restates previously released guidance, including All Provider Bulletin 355, and (2) supersedes MCE Bulletin 74. As we noted in the April and February 2022 newsletters, previous MassHealth bulletins included information on services ineligible for telehealth delivery and required the use of certain telehealth modifiers to indicate the modality used to deliver services.
Reprocessing Claims for Dates of Service on or after April 16, 2022 through February 28, 2023
As a result of this MassHealth guidance, Tufts Health Plan will reprocess eligible telehealth claims that were previously denied for not including modifiers 95 (services rendered via audio-video telehealth), V3 (services rendered by audio-only telehealth), and GQ (services rendered via asynchronous telehealth), and reimburse them, as appropriate. This applies to claims with dates of service April 16, 2022 through Feb. 28, 2023.
Modifiers required as of April 1, 2023
The requirements to use certain telehealth modifiers, including a modifier for institutional claims, have been amended and reinstated by MassHealth. The MassHealth guidance is effective for the dates of service on or after April 1, 2023 and expected to remain in place through at least Sept. 30, 2023.
As of April 1, when submitting a professional claim for services provided by telehealth, providers must use Place of Service (POS) 02 or 10 and must append one of the following modifiers: 95, 93, FQ, FR, and/or GQ. Tufts Health Plan will deny professional telehealth claims that do not include the appropriate modifier. Additionally, if a distant-site provider submits an institutional claim, the provider must append modifier GT on the institutional claim when there is an accompanying professional claim containing POS 02 or 10.
For additional information, please refer to the Telehealth/Telemedicine Payment Policy.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Jesse Salvato, Stephen Wong