Q&A: Billing for outpatient therapy services

February 22, 2021
Medicare Web

Q: During the public health emergency, are outpatient therapy services provided to a patient located in their home or a clinic billed in the same way as outpatient therapy services provided to a patient whose home has been designated a provider-based department (PBD)?

A: For the duration of the public health emergency, a hospital may bill outpatient therapy services in two ways:

  1. As Category 1 remote services, if the patient is registered as an outpatient and the patient’s home is made a PBD to the hospital
  2. Via telehealth with modifier -95 attached, without making the patient’s home a PBD to the hospital/CAH

In either case, payment will be what it would have been if services had been delivered in the normal setting.

For more information, see "Note from the instructor: Creative delivery of outpatient hospital services during the COVID-19 PHE, Part II" by Judith Kares, JD.