Rebilling Period Provided for Telehealth Claims Denied Using TOB 02

May 4, 2022

The Department of Health Care Services (DHCS) previously published the Medi-Cal Update titled “Medi-Cal Payment for Telehealth and Virtual/Telephonic Communications Relative to the 2019-Novel Coronavirus (COVID-19)” to instruct outpatient providers to bill claims with Place of Service (POS) code “02” in conjunction with the appropriate telehealth modifier.

The DHCS Policy Division has clarified that POS code 02 is only to be billed on a CMS-1500 claim form. Outpatient providers that submitted claims with a Type of Bill (TOB) “02” for telehealth services were erroneously denied with Remittance Advice Details (RAD) code 0062: The Place of Service is not acceptable for this procedure.

For dates of service March 1, 2020, through October 31, 2021, outpatient providers may rebill their claims that denied for RAD code 0062. The TOB should include the appropriate two-digit facility type code that reflects the type of facility where the service was provided. For a complete list of the facility type codes, please refer to the UB-04 Completion: Outpatient Services section in Part 2 of the Medi-Cal Provider Manual.

Telehealth claims must also be billed with an appropriate telehealth modifier, as follows:

  • Modifier 95: synchronous, interactive audio and telecommunications systems

  • Modifier GQ: asynchronous store and forward telecommunications systems

Furthermore, the rebilled claims must include the following:

  • Delay Reason code “11”

  • “Rebilling telehealth services for claims denied using TOB 02” under remarks

Medi-Cal will waive the standard billing timelines to allow for rebilling of claims that were erroneously denied because of this issue until July 31, 2022.

Updated provider manual sections will be released in a future Medi-Cal Update.