Yes, a physician order will be required for COVID-19 laboratory testing as with other laboratory testing. Also, as with all clinical laboratory services, there will continue to be no copayment required as these services pay at 100% of the Clinical Laboratory Fee Schedule.
Yes, pharmacies are still permitted to furnish vaccines in nursing homes. However, as of 7/1/2023 SNFs must serve as the billing entity for any vaccines furnished to patients in a Part A covered SNF stay under consolidated billing.
The GT modifier is not used for professional services submitted to Medicare.
The Department of Health and Human Services HIPAA regulations require a HIPAA compliant platform be used. The PHE allowed for enforcement discretion during the PHE and that was extended through 8/9/2023. Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency contains the information regarding a compliant HIPAA platform.
Originally, CMS indicated that effective 5/12/2023 (after the PHE expired) only teaching physicians in residency training sites located outside of an MSA may meet the presence for the key portion requirement through audio/video real-time communications technology. However, CMS has since clarified that information through the CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency dated 5/19/2023 which now allows for this practice to continue for all teaching physician services through 12/31/2023. CMS has indicated in the 2024 Physician Fee Schedule Final Rule that this policy will remain in place through 12/31/2024. See MLN Matters® MM13452: Medicare Physician Fee Schedule Final Rule Summary: CY 2024
Yes, both are billable to Medicare. POS 02 is used when the patient is located in an appropriate originating site as described by Medicare telehealth policy in CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 190.2. POS 10 will be utilized when the patient is located in their residence to receive the telehealth service.
No, modifier 95 is no longer going to be used for these telehealth services after 1/1/2024. You would bill modifier FQ if the mental health service is provided using real-time audio-only communication technology.
No, CMS has not included these codes on the telehealth list so they cannot be provided via telehealth.
CMS has indicated on their website that based on the Consolidated Appropriations Act of 2023 Medicare beneficiaries can continue to receive telehealth services from their home through 12/31/2024. However, if the beneficiary is receiving the service at their home the physician may not bill for an originating site fee (Q3014).
No, effective 5/12/2023 these codes will only be allowed for established patients per the CPT code description and guidelines.
No, with the end of the PHE for Q3014 to be billed to Medicare the patient must be in a valid originating site location.
Yes, effective 5/9/2023, CMS added these codes to the CMS list of telehealth codes. Clinical Psychologists, PT/OT/SLP, Optometrists, Nonphysician practitioners (including Nurse Practitioner, Clinical Nurse Specialist, Physician Assistant, Certified Nurse Midwife), LCSWs, RDs and NPs may bill and be paid for these codes.