Adding Modifiers for Telehealth

• Go to Masters --> Service Codes
• Edit the code that you are allowed to bill telehealth for. Enter the modifier and the rate. As a reminder, all the rates and modifiers can be changed at manage payer page. However, it is required for the modifier to be added to the master service code list first.
  
• Click Save. Go to Masters --> Appointment Types. Create a Telehealth Appointment Type for the desired service (i.e., Assessment, Supervision, Parent Training). Each type of service will need its own telehealth appointment type.
• Click on Save. Go to Manage Payer --> Click on the edit icon for the payer that is allowing telehealth modifiers. Once you're in the edit payer screen go to Payer Service Codes.
• Click the edit icon for the CPT code you wish to add modifiers to. Add the modifier and rate. You can change the rate here if you bill the contracted rates. If you bill the payer your own fee schedule/rates, please leave the rate as is for now. 
• Click on save. Go to Payer Activity and then click on "Add Activity"
• In the "Add Activity" page, select the "Telehealth" activity on the upper right hand side of the page.
• Once you've selected the appropriate activity, click on "Add Service Code" on the upper left hand side of the page.
• Add the CPT code and modifier required for the selected Telehealth activity. 
• Please note if you use other modifiers (i.e., HO or HM) with the selected CPT code you may need to add them under the telehealth activity first.  For example, if you bill 97151-HO normally, you would add HO under "Modifier 1" and the telehealth modifier (i.e., 95 in this example) would go under "Modifier 2". We recommend asking your payer for clarification. 
• Click on Save. You will now be able to schedule this telehealth activity just like any other activity. 
• If you bill a higher rate then the payers fee schedule (i.e., contracted rate) then you would need to go back to payer service codes and change the modifier rate to the contracted rate.

Notes:

• Always check-in with your payer to determine if telehealth is allowed, which CPT codes they are allowing it for, and which modifiers they are allowing.
• Your payer may require you to bill using the "02" telehealth location code. Click here to find out more information on adding a telehealth location code. 
• Modifiers are not needed on the authorization page unless you want to separate the units across each modifier (i.e., direct vs telehealth) or if the payer has authorized a certain amount of units for a each modifier (i.e, 97151-GT = 8 units and 97151 = 24 units).