Telemedicine-telehealth billing guidance for Oregon Health Plan fee-for-service providers

REQUIREMENTS: By April 20, 2020 (two weeks from policy date for system changes): (1) Billing team must configure all telemedicine claims to use Place of Service 02. (2) For physical health: Add modifier 95 to all synchronous video/audio claims; use Place of Service 02 only (no modifier) for telephone-only services. Bill retroactively to January 1, 2020. (3) For behavioral health: Use GT modifier as specified on behavioral health fee schedule for audio-video services; use Place of Service 02 with no modifier for telephone-only services. (4) For oral health: Use Place of Service 02 for all teledentistry services regardless of modality; no modifiers required. (5) Update provider credentialing to allow service delivery from home, office, clinic, or other private settings. (6) Providers must obtain and document verbal patient consent for all telemedicine services prior to delivery. (7) Billing staff must allow new patients for telemedicine services during COVID-19 emergency without established patient verification. (8) Update claim submission guidance to reflect that OHA will not audit HIPAA encryption compliance during emergency declaration. (9) Clinical staff should default to live audio/video when available, but telephone is acceptable when equipment/access barriers exist. Failure to use correct Place of Service (02) and modifiers will result in claim denials or payment delays.