Billing and Reimbursement

Q: Is there an end date to COVID-19-related telehealth coverage?

A: Any modifications to telehealth policies, including the sunsetting of any telehealth flexibilities authorized in response to COVID-19, will be communicated via Medicaid bulletin(s) in a manner that allows ample notice for providers and Healthy Connections Medicaid members to plan and ensure continuity of care. Policy changes and additional guidance and resources related to the COVID-19 pandemic are available at www.scdhhs.gov/covid19.

Q. What is the location code when billing telephonic and telehealth codes?

A. For COVID-19-related telehealth services submitted to the fee-for-service benefit, providers can elect to submit either ‘02’, indicating telehealth, or place of service code they would have used if the service had been provided in person (FQHCs billing through the SCDHHS webtool should select “POS 12”). Medicaid MCOs may have additional requirements related to the place of service for COVID-19 related telehealth services.

Q. Can you please advise on the proper use of this GT modifier? We use another code in the first block. Does this take that place or does it go in the second block?

A. When billing for a service with a GT modifier, the GT modifier should be listed after any other modifiers. For example, if you bill with a HO modifier and a GT modifier, HO should be included in the first block and GT should be included in the second block.

Q. Why is there a difference between covered dates of service and the claims submission acceptance date?

A. SCDHHS’ goal in preparing and responding to COVID-19 is to authorize services quickly, but the agency also needs time to update its system(s) to receive bills and reimburse for claims.

Q. Will telehealth services be reimbursed at the same rate as traditional services?

A. Telehealth services will be reimbursed at the same rate as traditional services, unless there is already an existing telemedicine code that follows one of the agency's benchmarks, such as Medicare, or a different rate is stated otherwise in a bulletin or guidance sent out by the agency. The South Carolina Department of Health and Human Services (SCDHHS) will continue to provide additional guidance as needed and will publish fee schedules as they are available for expanded telehealth services during this emergency response period.

 

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