Louisiana: Telehealth changes to COVID-19 temporary measures

The Louisiana Department of Health (LDH) revised the COVID-19 Informational Bulletin 20-5 on May 6, 2022.

Place of service code requirement changes
In addition to providing a CPT® code, all therapy providers must indicate the appropriate place of service, 02 (other than home) or 10 (home), based on the beneficiary’s location at the time of service. Providers must also append modifier 95. Services delivered via an audio/video system and via an audio-only system are to be coded this same way.

Telehealth
The Louisiana Medicaid fee-for-service (FFS) claim processing system is being updated to allow the appropriate teletherapy place of service code, 02 (other than home) or 10 (home), based on the beneficiary’s location at the time of service in addition to the procedure modifier 95.

FQHC and RHC
Non-Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) providers must indicate the appropriate place of service.

• Include place of service code based on the beneficiary’s location at the time of service:
  • 02 (other than home)
  • 10 (home)
• Append modifier 95 on the header and on all detailed service lines
• Services delivered via an audio/video system and via an audio-only system should be coded the same way
• Reimbursement for FQHC and RHC services will be at the all-inclusive prospective payment rate on file for the date of service

Outpatient hospital facilities
For telehealth at outpatient hospital facility the place of service 02 (other than home) or 10 (home) telehealth guidance for professional claims does not apply for telehealth billing on the UB 04 Form.

EPSDT
When coding for normal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) preventive services, code by age (99381- 99385, 99391-99395) and include:

• Telehealth modifier (95)
• Reduced services modifier (52)
• Appropriate place of service based on the beneficiary’s location at the time of service, either:
  • 02 (other than home)
  • 10 (home)

Secondary claims
When submitting secondary claims (Third Party Liability – TPL) for telehealth, Gainwell Technologies will allow the secondary claims and encounters if:

• A primary insurance claim for telehealth services was submitted with a place of service equal to the primary carrier’s billing requirements, and
• Modifier 95 is appended to the procedure code for a covered service

Place of service 02 (other than home) or 10 (home) will not be required for these claims. This instruction also applies to MCOs.

Questions?
Call Provider Services at 866-675-1607, 7 a.m. – 7 p.m., Monday – Friday.

CPT® is a registered trademark of the American Medical Association.

PCA-1-22-02081-C&S-News_06242022