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Billing Insurance Claims For Telehealth Appointments (US)

Note that this guide is intended for our US customers that bill insurance

In today’s climate, it is more common for practitioners to offer virtual appointment options to their clients. When billing insurance for virtual services, it is important to consider each insurance company’s requirements for billing Telehealth services because these requirements can vary across companies and change over time (especially during a pandemic).

This is especially important to consider if your practice offers a mix of in-person and virtual appointments.

The two most common requirements to consider when billing virtual appointments are Place of Service Codes or POS Codes (Box 24B on the CMS1500), and CPT code Modifiers (Box 24D on the CMS1500). This guide covers how these areas are set on both your paper and electronic claim submissions.

Key Takeaways

  • Each insurance company can have different requirements for billing Telehealth services, so it’s best to confirm a company’s Telehealth guidelines before billing claims.
  • Each location is set up with a default POS Code.
  • If you offer a mix of in-person and Telehealth services at the same location, your location default POS Code might not work for all claims at that location.
  • You can override the location default POS Code for electronic claims on the Pre-Flight EDI submission screen.

Place of Service (POS) Codes

When billing a professional claim, you are required to indicate the type of facility where each procedure was performed. Each facility type has an assigned two digit qualifier, and that qualifier is sent in Box 24B of the CMS1500 for each CPT billed. For example, a facility registered as an Independent Clinic has a POS code of 49. For more information on the POS Code set, have a look at the most up to date code set at cms.gov.

Default Location POS Code

In Jane, when you submit a paper or electronic claim, the default location POS code for the location of the appointment is used in Box 24B for each procedure being billed.

Default location POS Codes are set when creating or editing a location in Settings > Clinic Info & Locations > Edit/New Location.

Billing With a Different POS Code

If you offer a mix of Telehealth and in-person appointments at the same location, you might need to use a different POS Code depending on the services being billed, and the insurance company’s requirements. In these cases, you can’t rely on your default location POS Code.

However, it is easy to change your POS Code on the fly for electronic claims!

When generating a batch EDI claim submission, the last steps before creating your batch file is to review each claim submission in Pre-Flight View. The Pre-Flight View shows you the important information for each claim in your batch to make it easy to spot anything that looks out of sorts. This includes the POS Code for each claim in your batch. You can find this under the Location section of each claim in your batch.

If you’ve selected an appointment in your batch (i.e. a Telehealth appointment) that needs to be submitted with a POS Code that is different from your location default (i.e. 02 - Telehealth), then simply use the POS Code dropdown in the Pre-Flight to change the code for that claim!

Note that you will need to manage this on a case-by-case basis.

CPT Code Modifiers

Some insurance companies may require that you bill Telehealth services with your ‘normal’ in-person POS Code. Instead, a company might require that you use a special Modifier to indicate that a service was performed virtually.

We cover how to add modifiers on a case-by-case basis in the following guide: CPT & Diagnosis Codes

Likewise, we cover how Default Modifiers can help speed up your billing workflow in the following guide: Billing Code Default Allowed Amounts & Modifiers

Note that at this time, there isn’t a way to configure Default Insurance Specific Modifiers. If you bill one or more insurance companies that have unique requirements for the same CPT code, then modifiers will need to be managed on a case-by-case basis.

We have an existing feature request for Default Insurance Specific Modifiers. If this feature would help your practice manage insurance, please click here to view the feature request and add your vote!