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Date: March 20, 2020
To: HPSJ Providers, Practices (PCPs & Specialists), Hospitals and Ancillary Facilities
From: HPSJ Claims Department
Subject: Telehealth Billing
Business: Medi-Cal

There is no difference in reimbursement rates
for office and telehealth visits.

For office billing operations – including billing services – please note the following.

  1. HPSJ has always had the ability to accept and process telehealth claims.
  2. Providers seeing members via telehealth should bill using the appropriate visit code.
  3. This is the same visit code they would bill if the HPSJ patient were being seen in the office:
    1. Use Modifier 95 – and place of service would be 02
    2. Modifier GT is no longer a valid telehealth modifier and should NOT be used (95 replaced GT)
  4. Reimbursement is based on the provider’s contract:
    1. If visits are covered under a capitated agreement, there is no additional (FFS) reimbursement
    2. A visit is a visit (whether in office or by telehealth)
  5. For encounter purposes: It is important to bill the appropriate setting (in office or via telehealth)

Providers should review the MCL Provider Manual Guidelines for Telehealth Services for additional guidance. Watch for HPSJ Provider Alerts with updates as they come in from the CDC and DHCS.

Prop 56 Supplemental payments –
Telehealth services qualify for these, the (same as in-person office visits)

Clarification (March 10, 2020 Alert) – Billing

  • U07.1 is for confirmed cases only and is not available to bill until 04/01/2020.
  • B97.29 should be the diagnosis code providers use for confirmed cases through 03/31/2020.

Any testing or visits, prior to confirming a COVID-19 positive case should be billed with diagnosis codes pertaining to the patient’s symptoms at the time of the visit.

You should not bill diagnosis code B97.29 or U07.1 in order to be reimbursed for testing.

Posted on March 20th, 2020 and last modified on September 9th, 2022.