The Centers for Medicare & Medicaid Services (CMS) will implement a new place of service (POS) code related to telehealth and update an existing one on April 4. POS codes refer to where medical services are provided.
These changes will affect Texas physicians caring for Medicare patients and include:
POS 02, which has been revised and now corresponds to telehealth provided when the patient is located somewhere other than at home; and
POS 10, a new code that corresponds to telehealth provided when patients are at home.
Physicians will need to implement the new codes by the deadline. To do so, they should inform their billing staff of the changes and upgrade their electronic health record (EHR) system to accommodate the updated code set.
CMS claims the two codes will help meet overall industry needs amid the COVID-19 pandemic and standardize code requirements among insurers.
“While Medicare doesn’t always need this greater specificity to appropriately pay claims, it adjudicates claims with the new codes,” according to a CMS press release issued on Oct. 13. “This eases coordination of benefits and gives other payers the setting information they need.”
The Texas Medical Association supports using the two codes for all claims that require POS information and encourages physicians to upgrade their EHR and billing systems to accommodate the changes. If physicians do not use the proper POS code, their claim could be denied.
However, TMA has also raised some concerns that the update might cause confusion and unnecessary legwork for physicians.
Robert Bennett, TMA’s vice president of medical economics, says the distinction between POS 02 and POS 10 does not affect the telehealth services that patients receive, making that distinction irrelevant. He says the extra level of verification is “administratively burdensome.” TMA will monitor the administrative impact of the code changes.
In addition, the American Medical Association’s Current Procedural Terminology Editorial Panel approved a new CMS telehealth code modifier during its September 2021 meeting. Modifier 93 corresponds with a real-time medical service provided by telephone or another audio-only technology. It took effect Jan. 1.