The 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”
CMS officially has designated a Place of Service code for all of the telehealth to be “02” starting April 1, 2020. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information.
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.
Want to Maximize Telehealth Reimbursement?
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.
Hello
We are a Peds office in Maryland and do not participate with Medicare. Medicaid wants POS 11 and it seems like most commercial insurance so far want the POS 11 as well. Today we started receiving denials from Aetna stating they want POS 02. Does this seen correct? Do you know if there is a better way to confirm what insurance wants it one way or the other rather then waiting for the denials to roll in. I could spend days researching websites or all my insurance carriers. Who wants what modifier and what POS….