School-Based Health Care Services (SBHS) notification
April 7, 2022
SBHS telehealth billing updates effective 7/1/2022
Which place of service (POS) do providers use when providing SBHS via audio/visual telemedicine or audio-only telephone?
The place of service (POS) allowed for SBHS provided via telephone (audio-only) and telemedicine (HIPAA-compliant audio/visual telecommunication) will be changing as of July 1, 2022.
For dates of service on and after July 1, 2022, IEP/IFSP services provided via telephone or telemedicine through the SBHS program must be billed using the appropriate SBHS procedure code (found in the SBHS Billing Guide) and one of the following POS:
- POS 02 (telehealth provided other than in the patient’s home)
- The student is not located in their home when receiving services through telecommunication technology (i.e. student located at school or daycare and provider is located at a distant site).
- POS 10 (telehealth provided in patient’s home)
- The student is located in their home when receiving services through telecommunication technology (i.e. provider is located at school or office and student located at home).
Which modifier do providers use when providing SBHS via audio/visual telemedicine or audio-only telephone?
- Modifier 93
- For dates of service on and after July 1, 2022 claims billed for services provided via telephone (audio-only) must be billed with modifier 93 (synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system).
- Note: A list of eligible codes that can be provided and billed via audio-only telephone can be found in the SBHS COVID-19 FAQ.
- Modifier 95
- Services provided via HIPAA-compliant audio/visual telemedicine platforms will continue to be billed with modifier 95 (synchronous telemedicine service rendered via real-time interactive audio/visual telecommunications system).
Can providers still use the three phone codes listed on the SBHS COVID-19 FAQ when providing services via audio-only telephone?
Effective for dates of service on and after July 1, 2022, the three phone codes (98966, 98967, and 98968) that were temporarily allowed during the COVID public health emergency will no longer be billable through the SBHS program. When billing for audio-only service delivery after 7/1/2022, providers must bill the appropriate CPT or HCPCS code with modifier 93 and either POS 02 or POS 10 as outlined in Q-4 in the SBHS COVID-19 FAQ.
SBHS COVID-19 FAQ
Additional information about these changes have been added to the SBHS COVID-19 FAQ. The SBHS COVID-19 FAQ is available on the SBHS webpage under "Resources".
Questions?
Any questions regarding this notification and these changes should be directed to the SBHS program manager. Thank you for your continued participation in the SBHS program!
*Please note this bulletin is strictly related to the SBHS program (IEP/IFSP services) and is not relevant to managed care claims and/or school-based health center/clinic claims.
About the SBHS program
The Washington State School-Based Health Care Services (SBHS) program is administered by the Health Care Authority (HCA). School districts participating in the SBHS program may receive reimbursement for providing health care-related services to Title XIX Medicaid-eligible students with Individualized Education Programs (IEPs) or Individualized Family Service Plans (IFSPs). Visit the SBHS webpage for more information.
Please feel free to share SBHS news with your colleagues!
If you are not currently subscribed, sign up to receive SBHS updates.
|
