Depending on when you accessed CMS’s telehealth billing guidelines, you may have submitted claims using a Place of Service (POS) of “02” regardless of where you rendered the service instead of POS 11 if in the office. CMS recently announced that the POS 02 code applied a facility payment differential and lowered the payment of your claim.
Providers can now appeal the payment of any Medicare FFS claim for telehealth services, dated 3/1/20 or later, that used a POS 02. The process for requesting the appeal is as follows:
This appeal must be requested in writing. Providers can request the appeal of a Part B claim through the following methods:
- Submit your completed form via fax
- Submit your appeal via the redetermination function through the Secure Provider Online Tool (SPOT).
When requesting an appeal, you must specify the reasons you disagree with the initial determination.
- When completing the fax form, indicate in the additional narrative “Revising billing related to COVID-19 telehealth claims”
- When requesting via the redetermination function through the SPOT, indicate in the reason for the request “Revising billing related to COVID-19 telehealth claims” and be specific about what you want changed per detail line.