For Medi-Cal members, bill for telehealth services in accordance with theDHCS Provider Manual Telehealth requirements.

For Commercial members:

• Use the normal place of service code (11, 23, etc.) – excluding FQHC/RHCs.
  • Use of place of service codes "02" or "10" are accepted when used correctly per the code’s descriptor. Pricing using the Medicare physician fee schedule will result in payment parity in either situation for commercial claims.
• Use appropriate modifiers – excluding FQHC/RHCs.
  • Modifier 95 (synchronous, interactive audio and telecommunications systems); or
  • Modifier GQ (asynchronous store and forward telecommunications systems).

For Medicare members:

• Bill in accordance with CMS requirements.
• Use of place of service codes "02" or "10" are accepted when used correctly per the code’s descriptor. Any related pricing using the Medicare physician fee schedule will apply the applicable Medicare rate for the place of service code used (facility rate for place of service “02” and non-facility rate for place of service “10”) in accordance with CMS guidelines

Below are some examples (not exhaustive) of benefits or services that would not be appropriate for delivery via a telehealth modality:

• Performed in an operating room or while the patient is under anesthesia.
• Require direct visualization or instrumentation of bodily structures.
• Involve sampling of tissue or insertion/removal of medical device.
• Require the in-person presence of the patient for any reason.