There was a lot of information provided prior to April 2022 regarding the change in place of service codes for telehealth. The new code- 10- was established and became a requirement for most commercial insurances. Medicare released many notices about this place of service change and providers were advised to start using it.
We started using it, too. However, along with this change came a decrease in reimbursement for basic outpatient codes. The allowable for 99213 for a psychiatrist in an office setting was lowered from $95.34 to $69.27. The allowable for 90837 for an LICSW in the same setting went from $116.43 to $102.11. After doing some research, we discovered that using place of service 10 resulted in the facility fee schedule, which is significantly less. Medicare released a statement on May 27, 2022 indicating providers should continue to use the office place of service code so all claims submitted between 4/4 and their publication were incorrectly paid.
We managed to recoup all the missed money by rebilling Medicare telehealth claims from date of service 4/4/22 on with the office place of service code (11) and 95 modifier. The difference in allowables was collected, and the difference in co-insurance was recouped from the secondary payers. Please note that just rebilling the claim results in a duplicate denial. You will have to complete a redetermination through the Medicare website; for our jurisdiction, it's Connex. It was a lot of work, but absolutely worth it for our clients.
Have questions about how to recoup your Medicare money? Feel free to reach out to our knowledgeable billing staff.
Premier Medical Billing, LLC
617-958-6502
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