CODING AND REIMBURSEMENT | Specialty Series: Telehealth

By Shreemanti Chakrabarty, Anna Marie Jilla, and Erin L. Miller

This article is a part of the September/October 2020, Volume 32, Number 5, Audiology Today issue.

In the era of COVID-19, it has become increasingly important to use different methods of clinical service provision to protect our patients’ health while still addressing their hearing, tinnitus, and vestibular health-care needs.

As audiology clinics increase their use of telehealth as a method for patient care, audiologists must understand how such changes also impact coding and billing. This article will discuss considerations and provide examples of billing and coding for telehealth services for audiologists.

Insurance coverage for telehealth services varies based on payer. It is unlikely that payers will cover a service delivered through telehealth if it was not already recognized as a covered service. In other words, non-covered services will remain non-covered if provided via telehealth. For specific or atypical situations, it is recommended that professionals contact the payer directly to obtain guidance on coding and billing for services provided via telehealth.

Telehealth Place-of-Service Codes and Modifiers

Health-care claim forms will typically have a space to indicate where the service took place. On the Centers for Medicare and Medicaid Services (CMS) 1500 health-care claim form, the place of service designation is reported in Box 24.b.

TABLE 1 provides the place-of-service designations most pertinent to audiologists.

• Place-of-service code 11—Office is primarily used for typical face-to-face procedures provided in audiology offices.
• Place-of-service code 02—Telehealth indicates that the services were provided through a telecommunication system.

Some payers may use modifiers to indicate services were provided via telehealth. The only modifiers applicable for audiology services are Modifiers -95 (Telehealth) and -GT (Telehealth).