Telemedicine and virtual services
Applies to:
Commercial group HMO, EPO, POS and PPO plans
Commercial individual MyPriority® plans
Priority Health Choice plans (Medicaid and Healthy Michigan Plan)
Priority Health Medicare plans
Medical policy
Telemedicine - 91604
Telemedicine billing
Place of service codes
Updated guidelines, effective Jan. 1, 2024
Professional providers should report the appropriate place of service (POS) code along with the appropriate modifier to indicate the virtual care method used.
POS codes:
- 02 – Telehealth provided other than in patient’s home
- 10 – Telehealth provided in the patient’s home
Modifiers:
- 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System
- 93: Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
- GT: Via interactive audio and video telecommunication systems
- GQ: Via asynchronous telecommunications system
Reference our Telemedicine medical policy (#91604) which outlines how our commercial and individual / ACA plans adhere to the list of services defined for synchronous and asynchronous telehealth services.
Facility telehealth billing guidelines align with CMS for reporting or revenue codes, HCPCS and modifier use.
We follow the telehealth guidelines defined by CMS and MDHHS for Medicare and Medicaid respectively:
- For Medicaid, click here to go to the MDHHS website and then select Billing and Reimbursement then Provider Specific Information – telehealth. See also details MDHHS released for telehealth service changes coming in 2024.
- For Medicare, reference CMS’ Telehealth Services Fact Sheet (MLN901705) for details on telehealth billing changes that will go into effect on Jan. 1, 2024. See also the codes found in CMS’ List of Telehealth Services.
Reference the guidelines below until Jan. 1, 2024
Professional providers: report the place of service (POS) code as if the member was seen in person, along with the appropriate modifier below to indicate the virtual care method used:
- 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System
- 93: Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
- GT: Via interactive audio and video telecommunication systems
- GQ: Via asynchronous telecommunications system
Reference our Telemedicine medical policy (#91604) which outlines how our commercial and individual / ACA plans adhere to the list of services defined for synchronous and asynchronous telehealth services.
We follow the telehealth guidelines defined by CMS and MDHHS for Medicare and Medicaid respectively:
- For Medicaid, click here to go to the MDHHS website and then select Billing and Reimbursement then Provider Specific Information – telehealth
- For Medicare, reference CMS’ Medicare Physician Fee Schedule Final Rule Summary: CY 2023 (MM12982) and the codes found in CMS’ List of Telehealth Services