My name is Carol Yarbrough, and I'm here to tell you about telehealth modifiers and espouse more on the place of service you will use. All right. These are some common modifiers for behavioral health, primarily telehealth, telebehavioral health. 

So 25. Talked about it a little bit a couple of presentations ago. Modifier 25. You only put this on the E and M code. Repeat after me. Write it down. 

If I provide a service, 99214 because I prescribed a medication, and then I provide a separately identifiable behavioral health service represented by another CPT code, I get the bill for both of them. 

99214 I know wait, something, something. The 25 means it's going on the E and M code. E and M code only. E and M. Shaking my finger. This is a-- this is a hard fought realization for people. 

They want to put it on the other code. Like that's the separate-- that's a separate service. E and M is going to pay more. Valuation and management is going to pay more. You want to identify that It is billable. It is separately identifiable. 

And darn it, you want to get paid for that. Put it on the 25. OK. Enough of that 93. It's audio only. Audio only. It's a 93 modifier. Unless you're in an FQHC or an RHC, then you use FQHC. 

Kind of easy to remember. FQ, FQHC. OK. 95, that is for audio, video, video, audio, telecom service. Unless the provider or the payer wants GT. Same thing. It's the original. 

What's the terminology? It's the GT. It's the original goat. It's the greatest modifier of all time of modifiers. No, it isn't, but it was the original modifier. AMA then developed 95. GT is only allowed on institutional claims billed by CAH. If you're a critical access hospital, method two providers. 

Not going to use 95, can use GT. And a lot of Medicaid, wants GT. Look at your billing policies. FR, people forget this. But a supervising practitioner was present. My big head's in the way here. I'm going to move my face around. 

Through a two way audio and video communication technology. So that means they're not sitting in the same room as a resident or anyone. It's a supervising practitioner. I'm an occupational therapist, and I'm supervising, no, no. I would only use this in a teaching situation. 

But your behavioral health person, your supervising, your student, your candidate, and doesn't mean you're in the other room looking through a glass per usual. It means you're far away. Everyone's in their own distant sight. 

Patient's here. I'm here. Providers here. Students here. Everyone's got their own computer, use that for. All right. Place of service 10. I'm giving you the big description. Big descriptor. 

Patient is located in their home. Ah. See, it's a location. Other than a hospital or other facility. Remember, I kept on saying a car, parking lot. Not while you're driving. Please patient. Please, provider, make sure your patient, if they say, I'm in my car driving, please terminate that session. 

You get upset during a session. You can get distracted by what you're hearing and seeing on a screen while you're driving. Parked car, yes. Driving, no. There you go. 

It's paid at the non-facility. Professional provider fee. Service rate. Medicare, physician fee service. Schedule. It's a schedule. Physician fee, schedule rate. Ugh. Did we get there? One moment. 

It's paid at the PFS rate. Harking back to the last session, I said, if you're a place of service 11, you're going to get paid 100%. And guess what, if you are at a facility currently and treating a physician in their home, you also get the non-facility PFS rate. 

They're trying to true up. CMS is kind of true up the mist dollars. Because you still got rent. You still got malpractice insurance. That everything that the G0463 pays for. you still got clinic rooms. 

You still maybe an MA help to room, put the patient into their video room for you got went through their medication stuff. Still got those expenses. So you're going to get paid at the non-facility rate. 

Because that's all you're getting. You're not getting a facility payment. You're not getting an originating site payment either. Because patients at home. They really focus this on behavioral health practitioners. 

Because guess what, you people see more patients via telehealth than any other service, and rightly so. You rock, man. OK. POS 10. So what I was saying before, it now-- it's always going to pay at the non-facility rate. 

During the pandemic, you're like, wait a minute. If I was at an HOPD, I thought I just put a 93 modifier on the CPT. Stop thinking that way. Blank slate. Be like Carol. Forget everything that I said in the last session occurred in the last four years. Forget all that. 

If the patient's at home, you get paid at 100% non-facility rate. It's right there in writing. You go out to the original document right here. I did let I forget things. But that's why we have URLs. Keep me honest. 

OK, place the service 02. Anywhere else that a patient doesn't consider their home. But it does mean a facility. It is a skilled nursing facility. It is a hospital. It is-- now, it says physician office in hospitals. 

Yeah, because if the patient is sitting in someone else's office, they're going to get the Q3014, which is that originating site fee they can bill for hosting. Yeah, it's a hostess fee. I'm the host, and this is your Doripenem. This is what you're going to pay me for, sitting in this room looking in that camera. 

Patient's not going to pay you. They're going to pay their 20%. What is it, 20% of $39 is $5. Don't do the math. It's very low. But it's paid at that rate because they're going to get the Q3014. 

Because these are split fees. Again, if a patient somewhere else, you only get paid for the professional portion. Somebody deserves that facility fee. It's not the distance site provider. It's the originating site provider. 

Because the patients park in there, they're taking up space, getting treated. So patient's not at home. Just remember that. You don't get paid 100%. You get paid split fee. 

Here are some lovely examples. A psychiatrist and a patient meet and everyone ends in-- OK, now I'm singing That's Entertainment. So I'm hoping, hopefully, this is entertaining you as well. 

The psychiatrist and the patient meet. Provider prescribes an Rx also administers psychotherapy via telehealth. So again 99214 because medication, right. New medication. There are risks inherent to taking drugs. Even if it's heart medication, even if it's for your thyroid, even if it's for foot pain. Ibuprofen can mess you up. 

There's risk inherent in all of this, and the risks translate to a higher level of E&M code, which is a 99214. Based on the table of risk, which you can locate for free on the AMA's website, which is in the 2023 Evaluation and Management Services Guide. 

All right. So you put the 25 on the E&M, right. Cannot emphasize this enough, folks. Plus a 90833, 95 modifier. Or no modifier. CMS hasn't specified to leave it off. We've been putting it on for such a long time. Just keep putting it on there. 

But the patients at home. Places are resistant. OK. Teaching psychiatrist joins a resident and patient encounter. Remember, everyone's in their own place. And you know what, the teaching physician only gets to bill for this encounter if everyone has their own computer. 

They don't get to sit-in the same room with a resident. They don't get to sit in the same room with the patient. Everyone's got to be on their own device and physically separated miles in between. 

Provider prescribes an Rx. They attest to the evaluation and management visit. I was personally present during key portions of the evaluation management. I reviewed the residents note indicated otherwise, or I don't agree, or need to embellish, not embellish, need to update for greater clarity. 

And I also administered my own psychotherapy. Da, da, da. Get to bill. 98214. Modifier 25 with that FR modifier. Plus 90833, FR modifier. Place of service 10. Maybe you want to put a 95 on there too. But FR goes first. 

I mean, FR does mean via telehealth. Be safe. Put all the modifiers. And certainly, if it's audio only, you want to put that 93 modifier following the FR. Don't forget. It's audio only. Same scenario. 

You do all the stuff, do all the documentation. FR, 93. There are spaces on the CMS 1500 that you can have multiple modifiers on each claim line. All right. Clinician and patient meet for psychotherapy via audio only. 

There is your modifier 93. Always have to have it for audio only. You need a modifier always. Place the service 10, which means telehealth encounter, telecom encounter in the patient's home. Not at a facility. 

But you know what. Something went wrong. Something went right. Patient just didn't want it. I have the capability as a provider. 93 modifier. Don't forget your attestation statement. And they're saying X, Y, Z. 

All right. What's the dollar difference? What is it? This is based on 2025 reimbursement. And remember, I mentioned that CF acronym the conversion factor, you take the conversion factor, and CMS multiplies the conversion factor. 

I think this year is $32. Something like that. We're down $2 from last year. Just know that. You're doing the same work for less money, unless they increase the RVU value by balancing and making sure Medicare. Endowment stays neutral. 

So the 90834 this year at a non-facility means that I get paid. OK. Work our users are the same. 245. Takes the same amount of effort. But there's practice expenses. 

There's people to pay. There's rent. There are plants to be maintained by your plant service that costs money. Maybe you employ a fish person to take care of those fish if you're a pediatrician in an office. You get 0.72 for that, whatever it is. 

Now, see how much higher it is for a non-facility? 0.72. Facility practice expense is 0.31. Kind of factored in because guess what, it's the cost of doing business in a place. 

As a provider, even though you're not paying the rent, it's going to cost money. It's still costing money. Malpractice RVUs, the same. You get 0.5 RVUs for that. Total non-facility RVU. That's your total RVU, Relative Value Unit ascribed to a service provided by a provider. 

3.22. OK, that's pretty high. That's a-- you're working hard for that. That's 45 minutes of talk therapy. That's talk. 45 minutes. If you're at a non-facility, you got $104.16 for that. 

That's the average payment nationally based on around $34 per RVU. Do the math. If I'm at a facility as a provider, I get 2.81 RVUs for that. Only pays $90. Guess what. My patients at home, everybody wins. 

We all get the $104.16. Makes sense. Because guess what, if I'm at a facility, my patients at a facility, they're going to get $40-ish to host the patient, which is $30. It's going to cost more to place a service differential in total. 

So 90 plus 30. 40-ish. What did we say? It was $39 this year. So it's going to cost a little bit more. But your expenses are higher at a facility. You got more people around. You got stuff, right. So anyway, that's the difference. 

This was short and sweet. Here are the-- here's the link for the Medicare learning network Matters publication. You just call it Matters, MLM Matters. Stuff to discuss. I have a-- I have a matter to talk about with you. This is what matters. 

It updated the place of service codes. Newest one was 27, which is street treatment. Love it. Medicare RVU file, Relative Value Unit file can be found here. And each year, they publish the new fee schedule. You can see how they go up and down. 

Pick favorite code. Go back through time. See how it's either risen in value, stay the same, gone up over the last decade if you like. But this is where we take that. You take the Relative Value Unit file, you multiply it by the conversion factor. 

Each RVU, the total RVU. Multiply it by the $32 per unit. $33 per unit. And that's going to be your payment from CMS. Now, commercials. That's based on contracted amount agreement. 

And for Medicaid, that's going to be a bit less, as you know. Everyone seems to have the Medicare administrative contractors. They factor this for you. So if you go on to say Meridian site, NGS site, FCSO site, Novitas site, they will have where you can look up-- can either download the entire fee schedule based upon the geographic indices for your payment area. 

Northern California. Southern California. Washington State. Florida Brevard County. Southern Florida. I mean, it's just different for each Medicare administrative contractor is different. These schedules that they're publishing for different areas of the state. 

So you don't have to do the math. Because there's a whole geographic indices that gets factored in as well. Seattle is going to get paid higher than somewhere in Southern Washington. It's how well I know cities in Washington. I don't. Higher than Covington. All right. Thank you. Thank you for your attention.