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Revenue Cycle AI

Pediatric Video Visit Guide

A step-by-step guide to compliant billing for pediatric telehealth services, with specific examples for major payers.

Step 1: Core Requirements

  • Patient/Guardian Consent: Always obtain and document consent for telehealth services.
  • Eligible Technology: Use a secure, HIPAA-compliant platform with real-time, two-way audio and video.
  • Medical Necessity (UHC Example): UnitedHealthcare requires that the service would be considered medically necessary if performed in person. Source

Step 2: Billing & Coding

E/M CPT Codes for Telehealth

Standard office visit codes are used to bill for telehealth, paired with a modifier and specific Place of Service code.

CodePatient Status
99202-99205New Patient
99212-99215Established Patient

Note: Code level is chosen based on Time or Medical Decision Making (MDM).

Key Modifiers

  • Modifier 95: The standard for services via real-time audio AND video.
  • Modifier 93: Used for services via real-time audio-ONLY. Payer coverage varies.
  • Modifier GT: An older modifier now mainly used by some Medicaid and Commercial plans. Always verify payer requirements.

Place of Service (POS) Codes

  • POS 10: Use when the patient is in their home.
  • POS 02: Use when the patient is at a location other than their home (e.g., school, clinic).

Payer-Specific Example (UHC)

UnitedHealthcare requires billing with POS 02 or 10. Modifier 95 is accepted but not required for their Commercial plans, but may be required for state Medicaid plans. This highlights the need to always verify payer rules.

View UHC Policy

Video Walkthrough

Step 3: Payer-Specific Guidelines

  • Medicare: While less common for pediatrics, their policies often influence other payers. Source
  • Medicaid: Policies are state-specific. Always consult the state provider manual. Source
  • UnitedHealthcare Example: UHC's Commercial, Medicare Advantage, and Community (Medicaid) plans have distinct telehealth policies. Coverage for Medicaid plans is determined by individual state requirements. UHC Policies

Step 4: AAP Guidance

The American Academy of Pediatrics provides invaluable resources for best practices in pediatric telehealth.