Medicare Advantage telehealth rural health center and federally qualified health center claims

Anthem Blue Cross and Blue Shield (Anthem) has identified telehealth Medicare Advantage claims for rural health centers (RHC) and federally qualified health centers (FQHC) that have been billed incorrectly during the public health emergency (PHE). The claims that are billed incorrectly are for RHCs and FQHCs for which Anthem has contracted as professional groups (as opposed to facilities).

 

During the PHE, professional groups should be billing for telehealth services with the applicable professional telehealth service code or the evaluation and management code that represents the service rendered with modifier 95. However, professional groups are billing for telehealth services using only G2025. The only providers who should be billing G2025 are those contracted as a facility to bill, like Original Medicare.

 

Enhancements will be made to configuration that will begin denying claim lines for G2025 when billed on a professional claim form.

 

If you have any questions about this communication or any other item, please contact the Provider Services number on the back of your patient’s member ID card.

 

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