Create a Telehealth Procedure Code (Fee Grouping)

One way to set up a telehealth-specific procedure code is to create a Fee Group. A Fee Group in the Choice platform is a fee different than the "base" code. Once a Fee Group is added, the application will automatically use this fee on the claim for any patient who meets the selected criteria. For commercial telehealth claims, you will create a Fee Group by Service Location

  1. Go to Setup: Procedure Codes.
  2. Click the magnifying glass on the right to search for the existing code to be updated, and select it.

  3. Click the New button on the toolbar. A window will open. The existing code being updated will be in the box; click Next.

  4. The second screen will display the existing fee groups and allowed amount. Click New Fee to continue.

  5. A box will pop up asking you to choose how you would like to add the code: From the QuickEntry selection window, or From the Procedure Code setup screen. In this circumstance, the Procedure Code setup screen is easiest.

  6. Enter the Effective Start Date, and the Fee Group selection(s). If this is for commercial payers, you only need to enter grouping information in the Location.

  7. Save

  8. The new fee will be visible on the Code Summary page.

  9. On the left, select the Fees tab.

  10. Enter in all the appropriate information; usually will be the same as the base code, then Save. Complete the Billing tab if necessary to designate that the code can only be used once per day.

  11. Next, on the left, select the Default tab.

  12. On the Default tab, add the appropriate Default Modifier (95 for commercial payers, GT for Medicare), and Save.

  13. Repeat as needed for each code requiring the modifier.

  14. If you have different fees for different payers/financial classes, repeat these steps, adding a payer/financial class as one of your fee grouping options, in addition to the Service Location.