by Carol Hoppe, CPC, CCS-P, CPC-I
MedLucid Solutions, LLC
CMS announced in the October MLN Matters® that it would be updating the 2022 POS code set description of POS code 02, Telehealth Provided Other than in Patient’s Home, and adding new POS code 10, Telehealth Provided in Patient’s Home. According to CMS’ October MLN Matters, the POS changes would go into effect on Jan. 1, 2022, and be implemented on April 4, 2022. However, under the Public Health Emergency (PHE), WPS Medicare has instructed that we should continue to use the POS code where the patient would normally be seen by the provider rendering the telehealth service.
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.
Since the PHE has been extended into 2022, these guidelines will remain in place for Medicare through the end of 2022 or the calendar year in which the PHE is declared over.
Some commercial payers have adopted the new POS codes, while others are following Medicare's lead. For details, see the updated
Telehealth Payer Grid for 2022.
IHCP updates of note
Recent bulletins from the Indiana Health Coverage Programs (IHCP, or Indiana Medicaid) address reimbursement for administering remdesivir outside of a hospital inpatient setting and clarify IHCP’s new effective date policy for managed care entity (MCE) network participation requests. IHCP also announced that it has identified a claim-processing error for some psychotherapy and evaluation and management services provided on the same day.
Details on these and other IHCP bulletins can be found at the link on the
IHCP Bulletin homepage.
BT202202 - IHCP COVID-19 Response: IHCP revises remdesivir administration reimbursement policy.
BT2021112 - IHCP requests feedback for proposed 2022 telehealth and virtual services code set.
BT2021109 - IHCP clarifies MCE network participation request effective date policy.
BR202151 -
- IHCP to mass reprocess inpatient services that adjudicated incorrectly due to POA status.
- IHCP identifies psychotherapy and evaluation and management services on same day.
- IHCP to mass reprocess or mass adjust claims for select COVID-19 procedure codes.
- IHCP clarifies third-party liability cost avoidance announcement, specifies applicable services.