Providers must submit telehealth claims in accordance with applicable state and federal requirements. Tufts Health Plan will compensate in-network providers at 100% of their contracted rate for services rendered in person, as specified in provider agreements. The telehealth reduction will not apply. Note: Tufts Health Plan is not paying a separate rate for hosting a telehealth service for Commercial Products.
Services covered under telehealth should be clinically appropriate and not require in-person assessment and/or treatment. Tufts Health Plan defers to the provider to make this determination.
Note: Effective for dates of service on or after January 1, 2021, member copays and other applicable cost share will be applied to all non-COVID-19 telehealth services, with the exception of primary care and behavioral health telemedicine services for Rhode Island Commercial members. Member copays and other applicable cost share will continue to be waived for COVID-19-related, in-network, medically necessary services. A COVID-19 diagnosis must be submitted on the claim for the waived cost share to continue to apply.
Professional Claims
Providers should submit claims for telehealth visits, as outlined below.
Commercial and Tufts Health Direct
Submit claims with place of service (POS) 02
OR the appropriate telehealth modifiers (see table below) to differentiate a telehealth visit from an in-person visit.
Note: Tufts Health Plan will accept the POS that would have been used, had the services been rendered in person,
provided the appropriate telehealth modifier is also on the claim to indicate a telehealth visit.
Tufts Medicare Preferred
In accordance with CMS guidelines, submit claims with modifier 95 to indicate a telehealth visit.
Note: Providers should not submit claims with GO or GQ modifiers.
Tufts Health Plan SCO and Tufts Health Unify
In accordance with CMS and MassHealth guidelines, submit claims with modifiers GT and 95 and POS 02.
Tufts Health Together
In accordance with MassHealth requirements, submit claims with modifier GT and POS 02.
Tufts Health RITogether
In accordance with Rhode Island EOHHS requirements, submit claims with POS 02. Effective February 1, 2021, telehealth claims submitted with a POS other than POS 02 will deny.
Facility Claims
For facility claims, providers should submit the appropriate Revenue Code, CPT/HCPCS code(s) and modifier(s).
In addition to the guidelines above, providers should continue to bill with the appropriate license-level modifier and all other billing guidelines as specified in the applicable
payment policy.
Modifiers |
Modifier Description |
Modifier Definition |
95 |
Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System |
Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. The totality of the communication of information exchanged between the physician or other qualified health care professional and patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. Modifier 95 may only be appended to the services listed in Appendix P. Appendix P is the list of CPT codes for services that are typically performed face-to-face but may be rendered via real-time (synchronous) interactive audio and video telecommunications system. |
GT |
Via interactive audio and video telecommunication systems |
Modifier used to indicate telehealth services. Except for demonstrations in Alaska and Hawaii, all telehealth must be interactive. |
GQ |
Via asynchronous telecommunications system |
Modifier used to indicate telehealth services. Except for demonstrations in Alaska and Hawaii, all telehealth must be interactive. |
G0 |
Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke |
None provided |
Refer to the Temporary COVID-19 Telehealth/Telemedicine Code List for
Commercial,
Senior Products and
Tufts Health Public Plans for a list of common telehealth codes accepted by Tufts Health Plan. These lists are not all inclusive nor a guaratee of payment or final indiction of how specific claim(s) will be adjudicated.