Telehealth is here to stay, but the billing rules are a patchwork of post-PHE (Public Health Emergency) changes. Using the wrong modifier or Place of Service (POS) code is the #1 reason for telehealth denials. We'll break down the new standard.
Modifiers vs. Place of Service
Modifier 95:
- This is the CPT standard. Append this to the CPT code (e.g., 90834-95) to show the service was synchronous (audio/video).
Modifier GT:
- A common commercial/Medicaid modifier. Functionally the same as 95, but some payers still require it.
Place of Service (POS) 10:
- The new standard. Use this when the patient is at their home.
Place of Service (POS) 02:
- Use this when the patient is not at home (e.g., at a local clinic or originating site).
The Post-PHE Landscape
- Medicare: Continues to cover telehealth. Requires POS 10 for patients at home and pays at the "non-facility" rate.
- Medicaid: Varies by state. Most have adopted permanent telehealth coverage, but modifier/POS rules may differ.
- Commercial Payers: Most cover it, but policies on patient cost-sharing are reverting to pre-PHE status. Always verify benefits.
Audio-Only Services
"The biggest post-PHE change is audio-only. While Medicare extended audio-only coverage (using codes 98966-98968 or Modifier 93), many commercial payers have stopped. Billing a 90834 for an audio-only call is a major audit risk if the payer policy forbids it."
