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
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