HNFS updates billing guidance for TRICARE telemedicine services

July 23, 2020

Health Net Federal Services (HNFS) recently published updated guidance for physicians billing for telemedicine services provided to TRICARE enrollees. The guidance directs providers to bill the place-of-service (POS) code that represents the location from which the provider rendered the telemedicine visit to the TRICARE enrollee. For example, providers should bill POS 11 if the telemedicine services are rendered from the provider's office. The exception to this is for Applied Behavioral Health claims, which will continue to require the appropriate telemedicine modifier and POS 02 (telehealth) for all telemedicine claims.

Professional and facility telemedicine claims must also still contain one of the telemedicine modifiers (GT, GQ or 95).  

Previously, TRICARE had advised physicians to bill telemedicine claims with POS 02 (telehealth), regardless of the location from which the telemedicine was rendered. The notice indicates that telemedicine claims for professional services submitted with POS 02 may have been reimbursed at the facility CHAMPUS Maximum Allowable Charge (CMAC) rate, which is lower than the  non-facility CMAC.

Although HNFS had initially anticipated there would be no action required by physicians to resolve this issue, the notice states HNFS is unable to automatically reprocess affected claims. Impacted providers should submit a corrected claim with the actual POS to ensure claims are adjusted and paid at the appropriate reimbursement level. 

For additional information on TRICARE telemedicine or telemedicine billing tips, visit HNFS COVID-19 resource page or www.health.mil/coronoavirus.


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