CurrentHumanaPolicy CP2008102

Telehealth and Other Virtual Services

Defines Humana's claims payment and coding requirements for telehealth and other virtual services for Medicare Advantage and Medicaid products, and specifies provider, place-of-service, and documentation expectations that affect reimbursement.

Policy Summary

PayerHumana

PolicyTelehealth and Other Virtual Services

Policy CodePolicy CP2008102

Change TypeMaterial updates to POS/modifier reporting and audio-only identification

Effective Date02/2009

Next Review Date

Key ActionVerify member identity, obtain member consent, and ensure providers meet Humana telehealth credentialing and contracting requirements before billing additional telehealth services.

SourceLink

POLICY UPDATE CHANGES

For dates of service beginning January 1, 2024, providers must report place of service code 02, 10, or the applicable hospital POS with modifier 93 or 95 for additional telehealth services.

Humana requires providers to identify audio-only services with modifier 93.

Humana MA plans will apply Congressionally-authorized telehealth coverage waivers that expire December 31, 2027, and will apply applicable CMS limitations beginning January 1, 2028.

3required POS codes for 2024 (02, 10, hospital POS with modifiers)

Modifier 93audio-only identifier required

Q3014originating site HCPCS code referenced

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Humana Telehealth Coverage Criteria

Humana telehealth coverage criteria

Covered when ALL of the following conditions are satisfied:

ALL of the following

ALL of the following
- Provider must submit charges consistent with applicable CMS guidance for the date of service; Humana MA plans deny charges that do not satisfy CMS guidance, including billing guidance regarding the appropriate place of service code or modifier.
ALL of the following
- Service is listed in the member's applicable Evidence of Coverage.
- Provider is credentialed and recredentialed per Humana's telehealth standards and has a valid, effective contract with Humana.
- Provider meets licensure, certification, registration (including DEA if applicable), practices within scope of license, and meets professional practice standards in the state(s) where they practice and where the patient is located at the time of the encounter.
- Service is provided using real-time interactive audio technology (video encouraged when appropriate); all necessary code components must be possible with the technology used.
- Provider verifies the member's identity before providing the service.
- Member provides verbal or written consent to receive the service in accordance with state law.
- Member is present for the full duration of the service.
ALL of the following
- Services must be medically appropriate to furnish via telecommunications-based technology and coverable by the plan; applicable coding requirements must be satisfied.
- Physicians are responsible for supervising additional telehealth services provided by nonphysician practitioners within their practices to ensure conformity with requirements.
- Humana plans allow telehealth consistent with federal law and state Medicaid agency requirements for Medicaid members.

ALL of the following

For dates of service beginning January 1, 2024, report place of service code 02, place of service code 10, or the applicable hospital POS with modifier 93 or 95 as appropriate.
Audio-only services must be identified with modifier 93.

ALL of the following

Humana MA plans have applied Congressionally-authorized, coverage-related waivers to Original Medicare telehealth services; those waivers expire December 31, 2027.
Following CMS guidelines, Humana will apply applicable limitations beginning January 1, 2028, unless the service qualifies under the additional telehealth services benefit.

Key Codes, Modifiers, and Technical Requirements

Key HCPCS/CPT/Modifier referencesmixed

Q3014	Telehealth originating site facility fee (HCPCS)
G0071	Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication (FQHC/RHC only)
G2025	Non-mental health Original Medicare telehealth service reporting for FQHC/RHC
Modifier 93	Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
Modifier 95	Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

Real-time audio requirement

RequirementService must be provided using real-time interactive audio technology; video is encouraged when appropriate.

Code component feasibilityAll necessary components of the billed code must be possible to deliver with the real-time interactive technology used.

Member identityProvider must verify the member's identity before providing the service.

Member consentMember must provide verbal or written consent to receive the service in accordance with state law.

Member presenceMember must be present for the full duration of the service.

Provider Billing, Reporting, and Operational Requirements

Prior Authorization

Provider requirements for additional telehealth services

Providers must meet specific credentialing, contracting, verification, consent, licensure, and practice requirements before Humana will allow reimbursement for additional telehealth services.

Service must be included in member's Evidence of Coverage as an additional telehealth service.
Provider must satisfy Humana's telehealth credentialing and recredentialing standards and hold a valid, effective contract with Humana.
Provider must meet all applicable licensure, certification, registration requirements (including DEA registration if applicable) in the state(s) where they practice and in the state where the patient is located at the time of the encounter, and must operate within the scope of their license.
Provider must meet professional practice standards in the state(s) where they practice and where the patient is located.
Services must be delivered using real-time interactive audio technology; Humana encourages use of real-time interactive video when appropriate. All necessary components of the billed code must be possible using the technology employed.
Provider must verify the member's identity prior to providing the service.
Member must provide verbal or written consent to receive the service, in accordance with state law.

Terminology and Place-of-Service / Modifier Definitions

Telehealth services as a basic MA benefit (Section 1852(m))

Effective dateMA plan telehealth benefit beginning plan year 2020 under Section 1852(m).

Treatment as benefitThese additional telehealth services are treated as a basic benefit rather than a supplemental benefit.

Coverage conditionServices must be listed in the member's applicable Evidence of Coverage to be eligible.

Provider qualificationsServices must be provided by a clinician who meets Humana telehealth credentialing and contracting requirements and applicable licensure/DEA/scope rules.

Place of Service (POS) 02 and 10

POS 02Telehealth Provided Other than in Patient's Home.

Billing Rule

FQHC/RHC billing and reporting requirements

FQHCs and RHCs must follow applicable CMS guidance for reporting telehealth, additional telehealth, and other virtual services and use the correct procedure codes and modifier 95 where required.

Mental health Original Medicare telehealth or additional telehealth services: report with the applicable HCPCS Level II or CPT code for the service rendered (must be on CMS's List of Telehealth Services to qualify as Original Medicare telehealth; must be on Humana's additional telehealth services list to qualify as additional telehealth).
Non-mental health Original Medicare telehealth or additional telehealth services: report with HCPCS code G2025.
Other virtual services covered by Original Medicare but not classified as Original Medicare telehealth: report per applicable CMS guidance. For dates of service through 12/31/2025, FQHC/RHC providers should report with HCPCS code G0071; for dates of service beginning 1/1/2026, FQHC/RHC providers should report using the same service code as professional providers.
Append modifier 95 when reporting an Original Medicare telehealth service or additional telehealth service.