March 31, 2022
To: Contra Costa Health Plan (CCHP) Providers
RE: Updated information Telehealth Services
Contra Costa Health Plan (CCHP) follows all applicable Federal and State laws in the use of Telemedicine services to provide consultation, access and quality of care to our Medi-Cal and Commercial members. Based on a recent revision by the Centers of Medicare and Medicaid services (CMS), CCHP has updated the following on providing essential services by Telehealth:
- Telehealth services may be provided at a physician office, clinic setting, hospital, skilled nursing facility, residential care setting or patient home or other setting.
- The treating health care provider at the distant site believes the services being provided are clinically appropriate to be delivered via telehealth based upon evidence-based medicine and/or best clinical judgment.
- The member has provided verbal or written consent and it is documented in the medical record.
- The medical record documentation substantiates the services delivered via telehealth meet the procedural definition and components of the CPT-4 or HCPCS code(s) associated with the covered service.
- The services provided via telehealth meet all laws regarding confidentiality of health care information and a patient's right to the patient's own medical information.
- The patient is not precluded from receiving in-person health care services after agreeing to receive telehealth services.
CCHP providers must use the appropriate modifiers and CPT-4 or HCPCS codes when billing for services delivered via telehealth and document the Place of Service (POS) code on the claim effective for dates of service January 1, 2022, and after.
- POS 02: Telehealth Provided Other than in Patient's Home
Descriptor: The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
- POS 10: Telehealth Provided in Patient's Home
Descriptor: The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.
More information about Telehealth services is available on our website at cchealth.org/healthplan/providers or at the Department of Health Care Services website. If you have any questions, please contact CCHP by e-mail at Providerrelations@cchealth.org or by phone 925-313-9500.