The Indiana Health Coverage Programs (IHCP) has changed the telemedicine billing guidelines for Indiana Medicaid fee-for-service (FFS) and managed care benefit plans through the end of the COVID-19 public health emergency. The changes are required as of October 24, 2020, and providers can begin billing with the new guidelines immediately for dates of services on or after September 24, 2020.
According to IHCP, the new guidelines “better align with temporary Medicare billing guidance issued in response to COVID-19.” They require providers to bill for services rendered through telemedicine using the place of service (POS) code that would have been reported had the service been furnished in person, plus modifier GT – Via interactive audio and video telecommunication systems.
The new billing guidelines apply to all professional covered services rendered through telemedicine, including those listed in the IHCP Telemedicine Services Codes, except home and community-based services (HCBS) waivers*. The change will ensure that providers are reimbursed for services rendered through telemedicine at the same rate as if they were provided in-person.
As per previous guidance, the following provider types and services may not be reimbursed for telehealth (or what the payer refers to more specifically as telemedicine) by Indiana Medicaid: surgical procedures, radiological services, laboratory services, anesthesia services, audiological services, chiropractor services, care coordination without the member present, durable medical equipment/home medical equipment providers, and provider-to-provider consultation.
Prior to the October 24, 2020, change, providers were using two sets of billing guidelines to bill telehealth services to Indiana Medicaid. When billing from the IHCP designated list of Telemedicine Services Codes, providers were using POS code 02 and modifier -95, as specified in the IHCP Telemedicine and Telehealth Services Provider Reference Module. For IHCP covered codes not on the Telemedicine Services Codes list, providers were using the POS code most relevant to the member’s location, and the GT modifier was strongly encouraged but not required.
For more information, review IHCP bulletin BT2020106 published September 24, 2020.
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