![]() ![]() see Out-of-Network Payers, Non-Covered Service or Self Pay patients section below. Treat the patient as uncovered or self-pay.The patient’s health plan or the payer does not support or cover telemedicine.Finally, skip to the How To Bill Telehealth Services section below.Does the patient have any out of pocket expenses? (please review link on HHS/OIG Policy about the Stark Law requirements).Are there any specific documentations and/or notes that must be included on the when documenting the telemedicine visit?.Does the reimbursement rate for the services differ or equal from an in-person visit?.Are there any caps on telemedicine services for the patient’s benefit plan?.If the answer is yes on above, ask if authorization is required for the services.Would it be preferred to identified telehealth services by using the appropriate modifier or will the POS 02 be sufficient (validate this information with the providers medicare jurisdiction ).Would E/M codes be covered with GT, GO, 95 modifiers?.Are the CPT codes covered (be explicit and clear on the CPT codes for the service, i.e.Some questions we suggest asking in assessing coverage by commercial payers:.Always remember to document the conversation, ask the representative’s name and ask for a call reference number. We suggest you call the payer to assess the extent of coverage for telehealth services for this plan.The patient carries a health plan with a payer that covers telemedicine:.There are a number of scenarios that could exist with payers you are contracted with: HANDLING TELEHEALTH WITH IN-NETWORK PAYERS Please note, coverage and reimbursement varies from plan to plan, even within the same insurance company. Providers should contact their provider representative as this service might need to be added to their existing contracts. ![]()
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