Is G0459 covered for telehealth? (Medicare)
G0459 (Telehealth inpt pharm mgmt) appears on Medicare's approved telehealth services list, meaning Medicare will consider payment when the service is furnished via telecommunications technology under Medicare's telehealth rules. Coverage under commercial or Medicaid plans may differ and should be verified separately.
How to bill it
Bill G0459 with a place of service of 02 or 10, selecting whichever reflects where the patient was located during the encounter, and append modifier 95 to indicate the service was delivered via telehealth. Confirm your MAC's current claims requirements before submission, as edits can change. POS reference → · modifier reference →
Audio-only
Medicare's list of telehealth services doesn't specify audio-only eligibility for this code. Audio-only is permitted for a number of services (notably behavioral and mental-health care); confirm against current CMS guidance and your payer before billing audio-only.
Frequently asked
What's the difference between POS 02 and POS 10 for G0459?
POS 02 indicates the patient was not in their home for the telehealth service, while POS 10 indicates the patient was in their home. Choose the code matching the patient's actual location at the time of service.
Does modifier 95 apply the same way across all payers?
Modifier 95 is used here per Medicare's telehealth guidance for G0459, but commercial and Medicaid payers may have their own modifier and POS requirements, so always check the specific payer's policy.
Is G0459 automatically paid whenever billed with these codes?
No. Listing on Medicare's telehealth list and correct use of POS/modifier are necessary conditions, not a guarantee of payment; other coverage, documentation, and coding requirements still apply.
More free billing tools: all telehealth codes · telehealth checker · Medicare fee for G0459 · place of service · modifiers
Reflects Medicare's list of telehealth services for this year; audio-only, POS and modifier rules can change. Commercial and Medicaid telehealth coverage differ — verify current CMS guidance and your payer's rules before billing.
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