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Use correct coding to ensure your telehealth claims get paid

The Center for Medicare and Medicaid Services (CMS) has issued coding changes for services provided via telehealth or audio-only, effective Jan. 1, 2022. You can avoid unnecessary claim payment denials or delays by submitting correct coding on all claims.

Magellan requires the following information on claims billed for telehealth or audio-only services:

• Use the appropriate modifiers.
  • For telehealth services (combination of audio and live, interactive video): Include the GT or 95 telehealth modifier.
  • For audio-only services: Include the new FQ modifier. Learn more about changes effective Jan. 1, 2022.
  • Organizational providers billing professional services: Bill the license-level modifier in the first modifier field and the telehealth or audio-only modifier in the second modifier field. Example: 90791 AH, GT.
• Include the correct telehealth place of service (POS) code:
• If the member is in their home, bill POS 10.
• If the member is at a location other than their home, bill POS 02.
• Learn more about changes to POS codes effective Jan. 1, 2022.

Access helpful telehealth billing resources (and more) at MagellanProvider.com/telehealth

• Telehealth payable services 2022 - commercial plans (PDF)
• Telehealth payable services 2022 - Medicare plans (PDF)
• Telehealth billing instructions (PDF)
  • California telehealth billing (PDF)
• Organizations/facilities: Use license-level modifiers (PDF)