• COVID-19

DOH Telehealth Billing Guidance Update

Updated (5/5/20)

NYS Department of Health released updated Telehealth FAQs that include FQHC-specific guidance on billing for audiovisual telehealth and audio-only telephonic services. Per additional clarity from conversations with DOH and their webinar this morning (link pending, but will be available here), we want to highlight:

  • FQHCs may bill their full PPS rate (4013 in FFS) for FQHC billable providers (including LCSWs and clinical psychologists) delivering audio-visual telehealth services to patients located at any originating site, including the patient’s home. This includes when the provider is located in their own home. (See FAQ 57). These visits are eligible for wraparound payments when the patient is enrolled in Medicaid Managed Care. (See FAQ 52)

  • FQHCs may bill their offsite rate (4012 in FFS) for FQHC billable providers (including LCSWs and clinical psychologists) delivering audio-only telephonic services to patients, including when patients and/or providers are at home. These visits are eligible for wraparound payments when the patient is enrolled in Medicaid Managed Care. (See FAQ 52)

  • FQHCs may bill lower rates, as described in Lane 5 of the FAQs, for services delivered via audio-only telephonic services by providers that are not traditionally billable for a threshold PPS visit, i.e. RNs and nutritionists. (See FAQ 55.) Please note that licensing scope of practice rules apply.

Per DOH, these policies are in effect as of March 1, 2020 and will remain in effect until the end of the public health emergency or the issuance of additional NYS DOH guidance.

Previous Entry

The NYS Department of Health has just released updated Telehealth and Telephonic billing guidance and FAQs. CHCANYS is currently reviewing the guidance. Please note:

Lane 4, FQHC Offsite Licensed Practitioner Services: FQHCs should bill rate code 4012 for physicians, NPS, PAs, midwives, and other licensed practitioners who have historically billed under rate code 4012 for both telephonic and telehealth services.

FQHC Specific FAQs #52-58:

  • FQHCs will receive Medicaid wrap payments for telehealth and telephonic services

  • FQHCs can bill the 4012 rate code when the patient and/or practitioner are located in their respective homes

  • Guidance around POS and applicable modifiers specific to FQHC services

DOH will be hosting a webinar on May 5 from 10:30 am – 12:30 pm to review this updated guidance. Register for the webinar here.

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