Place of Service Update for Telemedicine Claims
Tuesday, July 21, 2020
Health Net Federal Services, LLC (HNFS) has been working with the Defense Health Agency (DHA) on implementing changes to TRICARE’s telemedicine benefit in response to the COVID-19 pandemic. Although our previous direction was for providers to use place of service (POS) 02 on all telemedicine claims, we recently received clarification from DHA that allows us to accept other POS codes. Moving forward, we ask providers to use the POS code that represents the location from which he/she rendered the telemedicine visit (for example, POS 11 if services are rendered from the provider’s office). CMS 1500 professional and UB04 telemedicine claims must still contain one of the telemedicine GT, GQ or 95 modifiers.
Exception: At this time, ABA claims continue to require the appropriate telemedicine modifier and POS 02 for all telemedicine claims.
Reimbursement and resubmission of claims
We are releasing previously held telemedicine claims. We recognize due to the use of POS 02, certain telemedicine claims for professional services may have been or will be reimbursed at the facility CHAMPUS Maximum Allowable Charge (CMAC) rate, rather than a non-facility CMAC. If you provided telemedicine services from a non-facility setting, you may submit a corrected claim with the actual HIPAA POS to ensure claims are adjusted and paid at the appropriate reimbursement level.
Although we initially anticipated there would be no action required on your part, we are unable to automatically adjust claims as the POS will vary from provider to provider.
As a reminder, TRICARE is temporarily allowing for audio-only telehealth. Additionally, TRICARE is waiving copayments for telemedicine rendered by network providers on or after May 12, 2020. This waiver applies to covered in-network telehealth services, not just services related to COVID-19.
Find additional information on telemedicine and TRICARE during the COVID-19 pandemic on our COVID-19 resource page and www.health.mil/coronoavirus. We also offer telemedicine billing tips online.