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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2017

Telemedicine/Telehealth Payment Policy

Harvard Pilgrim has developed a dedicated Telemedicine/Telehealth Payment Policy, which outlines our reimbursement of services administered when the physician or other health care professional and the patient are not at the same physical site.  

Telemedicine is the delivery of clinical services via synchronous, interactive audio and video telecommunications systems that permit real-time communication between the provider and the patient. Harvard Pilgrim’s new policy identifies covered services using telemedicine technologies — as well as the conditions that must be met for reimbursement. 

Effective for dates of service beginning August 15, 2017, Harvard Pilgrim will require that all telemedicine services be reported with either modifier GT (via interactive audio and video telecommunication systems) or 95 (synchronous telemedicine service rendered via a real-time interactive audio and video telecommunication system), and place of service (POS) 02. If you bill for telemedicine services with modifiers GT or 95, but without POS code 02 — or conversely, if you bill with POS code 02, but without modifier GT or 95 — Harvard Pilgrim will deny the service.

Additionally, please note that Harvard Pilgrim will apply a reduction to all telemedicine services; they will be reimbursed at 80% of the fee schedule/allowable rate for the in-person equivalent service. For more information about Harvard Pilgrim’s telemedicine coverage, please refer to the Telemedicine/Telehealth Payment Policy.

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Network Matters Archives

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Telemedicine/Telehealth Payment Policy

Change in Format of Newly Assigned Practitioner and Provider ID Numbers

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator