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Telehealth Changes for 2024 – Modifier 95 and Place of Service Codes

National Government Services has received many questions regarding the use of modifier 95 going forward. CMS implemented the usage of modifier 95 during the COVID-19 PHE as a means for providers to bill the service they provide via telehealth without using the traditional telehealth POS 02. Modifier 95 was allowed to be placed on a claim and it could be billed with the POS where the service would have taken place if it were provided in person. CMS ended that policy, with minimal exception, as of 12/31/2023.

CMS indicated in the 2024 Physician Fee Schedule Final Rule that billing with the modifier 95 would be allowed to continue when “the clinician is in the hospital and the patient is in the home, as well as for outpatient therapy services furnished via telehealth by PT, OT, or SLP.” These are the only scenarios where the usage of modifier 95 would be appropriate for billing fee-for-service Medicare. Any other telehealth service is billed with POS 02 or 10 dependent upon where the patient is located when the service is provided.

POS 10 is indicated in the final rule to be used when telehealth is provided to the patient in the patient’s home. This is further described by CMS as “a location other than a hospital or other facility where the patient receives care in a private residence.” POS 02 may be used when the patient is in a location other than their home.

CMS has clearly indicated that POS 10 is used when the patient is not in a hospital or other facility where a patient receives care. If the patient receives the telehealth service from a location that is not a facility they would normally receive care, such as their car or work, then POS 10 would be appropriate based on this description provided by CMS in the final rule.

You may find information related to these topics in section (4) Telehealth Practitioners in the final rule, page 78874-78876, posted in the Federal Register 11/16/2023 or via the CMS 2024 final rule..

You may also wish to review MLN Matters® MM13452 Medicare Physician Fee Schedule Final Rule Summary CY 2024.

Posted 1/18/2024