May 29, 2020
The Centers for Medicare & Medicaid Services (CMS) announced that institutional settings may now provide Medicare outpatient therapy services via telehealth and report them on institutional claims, such as the UB-04, if they are not included as part of a bundled institutional payment. This new development was released on May 28, 2020, on pages 70-71 of an updated CMS FAQ document [PDF] following ASHA and stakeholder advocacy seeking equitable expansion of Medicare telehealth services across settings.
According to CMS, outpatient telehealth services can be reported on institutional claims by applying modifier -95 to the appropriate service line. This applies only to services that can be billed separately from the institutional bundle, are paid under the Medicare Physician Fee Schedule (MPFS), and are included as an authorized service on the Medicare telehealth list. CMS specifically noted that speech-language pathology, physical therapy (PT), and occupational therapy (OT) telehealth services may be billed separately in this manner. However, audiology telehealth services were not addressed in this announcement. Outpatient audiology services provided in institutional settings are typically reimbursed as part of a bundled payment, such as the hospital outpatient prospective payment system (OPPS).
CMS provides guidance for specific settings including applicable type of bill (TOB) codes and services, as follows.
ASHA provides coding and billing guidance for Medicare telehealth services during the public health emergency. Contact firstname.lastname@example.org for additional information.