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/Virtual Services - 91604
Telemedicine billing
Professional providers
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/Virtual Services 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.
Facilities
Facility telehealth billing guidelines align with CMS for reporting or revenue codes, HCPCS and modifier use.
Medicare and Medicaid
We follow the telehealth guidelines defined by CMS and MDHHS for Medicare and Medicaid respectively:
- For Medicaid, visit the MDHHS website and select Billing and Reimbursement then Provider Specific Information – telehealth. Also, see 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 went into effect on Jan. 1, 2024. Also, see the codes found in CMS’ List of Telehealth Services.