We’re offering some reminders and clarifying information on billing for telehealth services for Tufts Health Plan Senior Care Options, Tufts Health Together, and Tufts Health Unify members.
In accordance with guidance from MassHealth and associated requirements outlined in Tufts Health Plan’s Telehealth/Telemedicine Payment Policy, when submitting a professional claim for services provided via telehealth, you’re required to use place of service (POS) code 02 (telehealth provided other than in patient’s home) or POS 10 (telehealth provided in patient’s home), as appropriate. In conjunction with POS 02 or 10, you must append one of the following modifiers (only these modifiers will be accepted for telehealth services) and only one should be reported per line:
- Modifier 93 – synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system (append to codes listed in Appendix T of the CPT Manual)
- Modifier 95 – synchronous telemedicine service rendered via a real-time audio and video telecommunications system (append to codes listed in Appendix P of the CPT Manual)
- Modifier FQ – telehealth service utilizing real-time audio-only communication
- Modifier FR – supervising practitioner was present through two-way, audio/video communication technology
- Modifier GQ – asynchronous telecommunications system.
We will deny professional telehealth claims that do not include an appropriate modifier. As a reminder, it is not appropriate to report modifier V3 (services rendered via audio-only telehealth) for Tufts Health Plan Senior Care Options, Tufts Health Together, and Tufts Health Unify members.
In addition, please keep in mind that if you are a distant-site provider and submit an institutional claim for a telehealth service, you must append modifier GT (via interactive audio and video telecommunications systems) on the institutional claim when there is an accompanying professional claim containing POS code 02 or 10.
For more information, refer to the Tufts Health Plan Telehealth/Telemedicine Payment Policy.
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