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Telehealth Reimbursement: Telehealth Place of Service Code (POS)

Texas HIPAA violationThe Centers for Medicare and Medicaid Services (CMS) is a government agency within the US Department of Health and Human Services (HHS). CMS oversees insurance billing code set in the United States.

HCFA 1500 Form

More precisely, as part of CMS, the Health Care Financing Administration (HCFA) establishes standards for medical providers to receive telehealth reimbursement. To successfully process a claim for the reimbursement then, healthcare professionals or their representatives must submit a form known as the “HCFA 1500 form” to the payor. That form requires specific information to be recognized for processing by the payor for telehealth services.

More specifically for telehealth reimbursement, the HCFA 1500 form must carry specific information related to the telehealth “Place of Service” to indicate that the service was delivered via telehealth technology. Note that CMS does not stipulate which telehealth technology is acceptable, but rather, that a “telecommunication system” is used.

POS is “02”

As the image on this page shows, CMS officially has designated a Place of Service code for all of the telehealth to be “02.”  We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information.

However, we are happy to give you some of that information here as well. Instructions on the CMS webpage are:

Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity where service(s) were rendered. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes…

In case your computer won’t allow you to see the text in the box at the bottom of the image, it is provided here for you:

The location where health services and health-related services are provided or received, through a telecommunication system. (Effective January 1, 2017)

How Can You Tell Which Specific Technology is Reimbursable?

Given the lack of specificity with regard to which technology is allowed, the cautious billing office will look at the definitions of practice that define the term “telehealth” in each state’s business code related to practice.

For more information about other telebehavioral health and telemental health reimbursement, see the Telebehavioral Health Institute’s “Telemental Health and Telebehavioral Health Reimbursement Strategies: Increasing Authorization & Payment.” This professional online training with 3 CME/CE Hours will review relevant telehealth, telemedicine, telemental health, and telebehavioral health reimbursement law and proper procedures for practitioners and consultants.

 


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