Major insurers changing telehealth billing requirement in 2022

Beginning Jan. 1, Anthem and UnitedHealthcare (UHC) will require commercial and Medicare Advantage plans to use new place of service (POS) code 10 for telehealth provided in the patient’s home. POS code 02 should continue to be used when telehealth is provided anywhere other than a patient’s home (e.g., a hospital or skilled nursing facility). 

Both payers are aligning with the Centers for Medicare & Medicaid Services’ (CMS) recent bulletin that revised POS code 02 and created POS code 10 as follows:

POS 02: Telehealth Provided Other Than in Patient’s Home – The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.

POS 10: Telehealth Provided in Patient’s Home – The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.

You can view Anthem’s virtual care policy for your state here. Under the “Category” drop-down menu, select “Evaluation and Management.” The “Virtual Visits” policy should populate toward the bottom of the screen. More information on UHC's virtual visits policies is available here.

During the COVID-19 Public Health Emergency (PHE), traditional Medicare will continue to require physicians to bill using the POS they would have used if the service had been provided in person. After the PHE, unless there’s a legislative change, CMS will revert to the geographic/originating site requirements for most telehealth services. Therefore, for traditional Medicare, POS 10 would only apply to tele-mental health services after the PHE. Per the CMS bulletin, the new POS code won’t be implemented under traditional Medicare until April 4, 2022, at the earliest. 

— Brennan Cantrell, commercial health insurance strategist, American Academy of Family Physicians

Posted on Dec. 27, 2021, by Brennan Cantrell