We are hearing of significant variability by MACs in their guidance on securing payment for e-visits. Just as a reminder, an e-visit is different than an email or telephone call and both fall short of true telehealth visits. Unfortunately, the MACs' guidance sometimes appears to be out of compliance with Medicare billing rules. An explanation of an e-visit can be found here: http://www.apta.org/COVID-19/E-Visit/QuickReference/
In Summary, to bill an e-visit, follow these simple steps:
- Bill the appropriate "G" Code
- Use POS 11, and
- add modifiers CR and GP.
If the MAC denies payment, look to the denial code, and call the MAC to confirm their rules. Some MACs have suggested that the GP modifier be dropped. CMS has described E-visit codes as “sometimes therapy” and as such require the GP modifier.
What should you do in this case? PPS does not recommend billing against CMS policy, and we hope that this will soon be cleared up by Medicare in its conversations with the MACs. PPS suggests if you have checked with your MAC and if they advise you to file an alternate method, be sure to maintain the reference number from your call.
