Telehealth: Required Modifier and Place of Service
| Date: | May 15, 2024 |
| From: | Health Plan |
| To: | Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Providers and Practitioners |
| Type: | Regulatory |
| Subject: | Telehealth: Required Modifier and Place of Service |
| Business: | Medi-Cal Managed Care |
Through the new Claims Editing System (CES), Health Plan identified the required modifier is missing, or the modifier billed is inappropriate for the place of service billed when billing services conducted via telehealth.
When billing for services conducted via telehealth a combination of correct place of service and modifier is required.
If Place of Service 02 is billed, modifier code 95 or GQ must be included on the same line.
If Modifier 95 or GQ is billed, POS 02 must be billed on the same line.
Please see below for additional information on Telehealth definitions and billing guidance.
Telehealth means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.
Modifiers consist of two characters which can be alpha, numeric, or alphanumeric. The Medicaid NCCI program defines modifiers that may be appended to HCPCS/CPT codes to provide additional information about the services rendered.
Place of service codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. The Centers for Medicare & Medicaid Services (CMS) maintain place of service codes used throughout the health care industry.
Place of Service 02 indicates the location where health services and health related services are provided or received, through telecommunication technology.
Synchronous, Interactive Audio and Telecommunications Systems: Modifier 95
Modifier 95 must be used for Medi-Cal covered benefits or services delivered via synchronous, interactive audio/visual, telecommunications systems. Only the portion(s) of the telehealth service rendered at the distant site are billed with modifier 95.
Asynchronous Store and Forward Telecommunications Systems: Modifier GQ
Modifier GQ must be used for Medi-Cal covered benefits or services, including, but not limited to, teleophthalmology, tele dermatology, tele dentistry and teleradiology, delivered via asynchronous store and forward telecommunications systems, including e-consults. Only the service(s) rendered from the distant site must be billed with modifier GQ.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG
