New Telehealth Code Sparingly Adopted

Despite the availability of a new Medicare code corresponding to telehealth provided to patients at home, Texas Medical Association payment staff say health plans are adopting it sparingly.

Place of Service code 10 (POS 10) was effective on Jan. 1 and became available for billing in April. However, Medicare says there’s no need to use the code until the COVID-19 public health emergency (PHE) has ended. The PHE is now in place through July.

TMA staff have identified only one commercial plan, UnitedHealthcare, that has adopted the use of POS 10 so far.

While Cigna’s Medicare Advantage plan allows billing for POS 10, Cigna has published guidance stating POS 10 shouldn’t be billed for its commercial plans.

In other recent health plan updates compiled by TMA staff:

  • Effective March 1, Aetna no longer pays CPT office consultation codes 99241 through 99245, New or Established Patient Office or Other Outpatient Consultation Services.
  • Humana now requires modifier FQ (counseling and therapy furnished using audio-only communication technology) when providing audio-only services if it’s impossible for patients to use video. Modifier FQ, a Healthcare Common Procedure Coding System modifier, took effect Jan. 1.
  • Both Cigna and Humana require credentialing of midlevel practitioners in order to join their practitioner networks. For the latest health plan updates, visit TMA’s Health Plan News page regularly.

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Last Updated On

April 20, 2022

Originally Published On

April 20, 2022

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